Provider Demographics
NPI:1376803585
Name:CARTER, SHELL
Entity Type:Individual
Prefix:MS
First Name:SHELL
Middle Name:
Last Name:CARTER
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 1:3417 OSIANA AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-7236
Mailing Address - Country:US
Mailing Address - Phone:702-518-0863
Mailing Address - Fax:702-644-0652
Practice Address - Street 1:3417 OSIANA AVE
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89031-7236
Practice Address - Country:US
Practice Address - Phone:702-518-0863
Practice Address - Fax:702-644-0652
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-22
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV082Medicaid