Provider Demographics
NPI:1275639817
Name:SHELTON, MARLON RAY (MHPP)
Entity Type:Individual
Prefix:MR
First Name:MARLON
Middle Name:RAY
Last Name:SHELTON
Suffix:
Gender:M
Credentials:MHPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:104 PROSPECT TRL
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72118-5211
Mailing Address - Country:US
Mailing Address - Phone:501-812-6443
Mailing Address - Fax:501-812-0560
Practice Address - Street 1:1405 N PIERCE ST STE 101
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72207-5379
Practice Address - Country:US
Practice Address - Phone:501-603-2147
Practice Address - Fax:501-603-0324
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health