Provider Demographics
NPI:1275979288
Name:CALTON, SHANNON JEAN (MS, LPCC)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:JEAN
Last Name:CALTON
Suffix:
Gender:F
Credentials:MS, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3146 PATSIE DR
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45434-6032
Mailing Address - Country:US
Mailing Address - Phone:513-324-2521
Mailing Address - Fax:
Practice Address - Street 1:3055 KETTERING BLVD STE 111
Practice Address - Street 2:POINT WEST III
Practice Address - City:MORAINE
Practice Address - State:OH
Practice Address - Zip Code:45439-1900
Practice Address - Country:US
Practice Address - Phone:937-424-0210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-16
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.1100543101YP2500X
OHC.1100543101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional