Provider Demographics
NPI:1083117105
Name:SHELTON, KATHERYN LEIGH (LMHC)
Entity Type:Individual
Prefix:
First Name:KATHERYN
Middle Name:LEIGH
Last Name:SHELTON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:KATHERYN
Other - Middle Name:LEIGH
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:610 N LEBANON ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:IN
Mailing Address - Zip Code:46052-1716
Mailing Address - Country:US
Mailing Address - Phone:765-680-0071
Mailing Address - Fax:765-680-0468
Practice Address - Street 1:610 N LEBANON ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:IN
Practice Address - Zip Code:46052-1716
Practice Address - Country:US
Practice Address - Phone:765-680-0071
Practice Address - Fax:765-680-0468
Is Sole Proprietor?:No
Enumeration Date:2018-03-15
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39003241A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health