Provider Demographics
NPI:1093094898
Name:SHELTON, SUSAN MILLETTE
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:MILLETTE
Last Name:SHELTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:473 COUNTY ROAD 45250
Mailing Address - Street 2:
Mailing Address - City:POWDERLY
Mailing Address - State:TX
Mailing Address - Zip Code:75473-4316
Mailing Address - Country:US
Mailing Address - Phone:903-732-4728
Mailing Address - Fax:
Practice Address - Street 1:208 N 2ND ST
Practice Address - Street 2:
Practice Address - City:HUGO
Practice Address - State:OK
Practice Address - Zip Code:74743-3854
Practice Address - Country:US
Practice Address - Phone:580-326-8373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-10
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health