Provider Demographics
NPI:1386440295
Name:KING, SHANNON (RBT)
Entity type:Individual
Prefix:MISS
First Name:SHANNON
Middle Name:
Last Name:KING
Suffix:
Gender:
Credentials:RBT
Other - Prefix:MRS
Other - First Name:SHANNON
Other - Middle Name:
Other - Last Name:MARSHALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:328 N 18TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:IN
Mailing Address - Zip Code:47362-3952
Mailing Address - Country:US
Mailing Address - Phone:765-575-2267
Mailing Address - Fax:
Practice Address - Street 1:3011 S 14TH ST
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:IN
Practice Address - Zip Code:47362-1845
Practice Address - Country:US
Practice Address - Phone:765-465-4290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-21
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INRBT-24-357358106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician