Shape Behavioral Services LLC

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

Legal business name

SHAPE BEHAVIORAL SERVICES LLC

Practice address

107 South Indiana Ave
Bloomington, IN 47405

Phone

(423) 281-4333

NPI assigned

Dec 2, 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 LLC Former legal business name

Locations

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

{
    "created_epoch": "1638403200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1685923200000",
    "number": "1932867322",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "722 S LIBERTY ST STE 218",
            "city": "MUNCIE",
            "state": "IN",
            "postal_code": "473052346",
            "telephone_number": "423-281-4333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 SOUTH INDIANA AVE",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "47405",
            "telephone_number": "423-281-4333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHAPE BEHAVIORAL SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-02",
        "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 LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Samiullah Shaikh
• Beverly J Shamloo, NP
• Shank & Wells Enterprises, LLC
• Tyler James Shank
• Kavya Shankar, MD
• Suzanne Elaine Sharp, MA,CCC-SLP
• Lauren Nicole Shaw
• Natasha Shaw
• Mari Lynn Shawcroft, M.A.
• Patricia A Shea, M.A.,CCC-A

• Behavior Analyst in Bloomington, IN
• Providers in Bloomington, IN by specialty
• Behavior Analyst in Indiana

• 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.