Provider Demographics
NPI:1720819592
Name:SHELLEY, BREANNE (MA, LBA)
Entity type:Individual
Prefix:
First Name:BREANNE
Middle Name:
Last Name:SHELLEY
Suffix:
Gender:F
Credentials:MA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13401 METRIC BLVD APT 923
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78727-3350
Mailing Address - Country:US
Mailing Address - Phone:435-262-2790
Mailing Address - Fax:
Practice Address - Street 1:8300 N FM 620 RD STE 100&400
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78726-4007
Practice Address - Country:US
Practice Address - Phone:435-313-2962
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-12
Last Update Date:2025-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst