Shape Behavioral Services LLC

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

Legal business name

SHAPE BEHAVIORAL SERVICES LLC

Practice address

625 S L Rogers Wells Blvd # 218
Glasgow, KY 42141-1074

Phone

(423) 281-4333

NPI assigned

Nov 22, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Alex Kiss

Title

Director

Phone

(423) 281-4333

Specialties & licenses 4

Addresses

Other names 1

• Shape Behavioral Services Former legal business name

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

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    "created_epoch": "1637539200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1685923200000",
    "number": "1154088417",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "625 S L ROGERS WELLS BLVD # 218",
            "city": "GLASGOW",
            "state": "KY",
            "postal_code": "421411074",
            "telephone_number": "423-281-4333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "625 S L ROGERS WELLS BLVD # 218",
            "city": "GLASGOW",
            "state": "KY",
            "postal_code": "421411074",
            "telephone_number": "423-281-4333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHAPE BEHAVIORAL SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-11-22",
        "last_updated": "2023-06-05",
        "certification_date": "2023-06-05",
        "status": "A",
        "authorized_official_last_name": "KISS",
        "authorized_official_first_name": "ALEX",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "423-281-4333"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "106E00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Assistant Behavior Analyst",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106S00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shape Behavioral Services",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• SCK Vision Care, PSC
• Martha Seeley, M.D.
• Tiffany Segura
• Zachary Ross Setters, MD
• Michael W Shadowen, M.D.
• Shawna M Shartzer, LCSW
• Erica L Shaw
• Alexis N Sherfey, APRN
• Manish Shetty, MD
• Amanda Jean Shimanek

• Behavior Analyst in Glasgow, KY
• Providers in Glasgow, KY by specialty
• Behavior Analyst in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.