Provider Demographics
NPI:1346644804
Name:SHELTON, SUSAN (LMHC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:SHELTON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 HOSPITAL DR NE
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32548-5063
Mailing Address - Country:US
Mailing Address - Phone:850-833-7500
Mailing Address - Fax:850-833-8528
Practice Address - Street 1:7 VINE AVE NE
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32548-5070
Practice Address - Country:US
Practice Address - Phone:850-682-1234
Practice Address - Fax:850-460-8348
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-13
Last Update Date:2019-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH12890101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health