Provider Demographics
NPI:1679378624
Name:AUSTIN, SHEA (RBT)
Entity type:Individual
Prefix:
First Name:SHEA
Middle Name:
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3006 EASTPOINT PKWY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-4185
Mailing Address - Country:US
Mailing Address - Phone:502-795-0773
Mailing Address - Fax:
Practice Address - Street 1:6640 PARKDALE PL STE R
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-4698
Practice Address - Country:US
Practice Address - Phone:317-383-0188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-14
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INRBT-24-400887106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician