Shayla Ebisch-Beavers, RBT

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

License

RBT-20-122667 Issued in OK

Practice address

3005 SW Park Ave
Lawton, OK 73505-7902

Phone

(580) 699-5558

Fax

(580) 699-5559

NPI assigned

Aug 20, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Onward Behavioral Services

  • Behavior Analyst
  • Wichita Falls, TX
  • NPI 1538951413
  NPD (past)

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

{
    "created_epoch": "1597881600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1597881600000",
    "number": "1679185672",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3005 SW PARK AVE",
            "city": "LAWTON",
            "state": "OK",
            "postal_code": "735057902",
            "telephone_number": "580-699-5558",
            "fax_number": "580-699-5559"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3005 SW PARK AVE",
            "city": "LAWTON",
            "state": "OK",
            "postal_code": "735057902",
            "telephone_number": "580-699-5558",
            "fax_number": "580-699-5559"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4084 Regent Dr",
            "address_purpose": "LOCATION",
            "city": "Wichita Falls",
            "state": "TX",
            "postal_code": "763081508",
            "country_code": "US",
            "telephone_number": "940-228-5297",
            "fax_number": "940-500-4025",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "EBISCH-BEAVERS",
        "first_name": "SHAYLA",
        "credential": "RBT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-08-20",
        "last_updated": "2020-08-20",
        "certification_date": "2020-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "OK",
            "license": "RBT-20-122667",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BACB BOARD",
            "identifier": "RBT-20-122667",
            "state": "OK"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "rosestreetlawton@outlook.com",
            "affiliation": "N",
            "address_1": "3005 SW Park Ave",
            "city": "Lawton",
            "state": "OK",
            "country_code": "US",
            "postal_code": "735057902",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Behavior Technician in Lawton, OK
• Providers in Lawton, OK by specialty
• Behavior Technician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2020; 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.