Provider Demographics
NPI:1922808906
Name:SHEA, ALEC BLAINE I (RBT)
Entity type:Individual
Prefix:
First Name:ALEC
Middle Name:BLAINE
Last Name:SHEA
Suffix:I
Gender:M
Credentials:RBT
Other - Prefix:MR
Other - First Name:ALEC
Other - Middle Name:BLAINE
Other - Last Name:SHEA
Other - Suffix:I
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:13185 OLD NASHVILLE HWY
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-6309
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13185 OLD NASHVILLE HWY
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-6309
Practice Address - Country:US
Practice Address - Phone:615-237-8360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-18
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician