Provider Demographics
NPI:1689470023
Name:TUCKER, SHELBY BREANN (LEP, BCBA)
Entity type:Individual
Prefix:MRS
First Name:SHELBY
Middle Name:BREANN
Last Name:TUCKER
Suffix:
Gender:
Credentials:LEP, BCBA
Other - Prefix:
Other - First Name:SHELBY
Other - Middle Name:
Other - Last Name:WAGNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:805 E ALAMOS AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93704-3104
Mailing Address - Country:US
Mailing Address - Phone:559-433-7726
Mailing Address - Fax:
Practice Address - Street 1:805 E ALAMOS AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93704-3104
Practice Address - Country:US
Practice Address - Phone:559-433-7726
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-24
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4557103T00000X
CA220108724103TS0200X
CABACB330712103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool