Provider Demographics
NPI:1053704536
Name:SHIRLEY, BRIGITTE (BCBA)
Entity type:Individual
Prefix:
First Name:BRIGITTE
Middle Name:
Last Name:SHIRLEY
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:BRIGITTE
Other - Middle Name:
Other - Last Name:MCMILLAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA
Mailing Address - Street 1:1166 E DAYTON YELLOW SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:FAIRBORN
Mailing Address - State:OH
Mailing Address - Zip Code:45324-6324
Mailing Address - Country:US
Mailing Address - Phone:207-814-8452
Mailing Address - Fax:
Practice Address - Street 1:3230 FAIRWAY DR
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45409-1212
Practice Address - Country:US
Practice Address - Phone:937-308-3966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-09
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1-14-16848103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst