Provider Demographics
NPI:1073627816
Name:SHELTON, ANGELA JANE (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:JANE
Last Name:SHELTON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:ANGELA
Other - Middle Name:SHELTON
Other - Last Name:LEACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:106 PINNACLE DR
Mailing Address - Street 2:SUITE 106
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37615-6602
Mailing Address - Country:US
Mailing Address - Phone:423-525-3771
Mailing Address - Fax:
Practice Address - Street 1:106 PINNACLE DR
Practice Address - Street 2:SUITE 106
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37615-6602
Practice Address - Country:US
Practice Address - Phone:423-525-3771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1383103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist