Provider Demographics
NPI:1437474467
Name:SHELTON, KIMBER (PHD)
Entity Type:Individual
Prefix:DR
First Name:KIMBER
Middle Name:
Last Name:SHELTON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 S MAIN ST
Mailing Address - Street 2:SUITE 214
Mailing Address - City:DUNCANVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75116-4700
Mailing Address - Country:US
Mailing Address - Phone:469-407-0381
Mailing Address - Fax:972-572-1069
Practice Address - Street 1:214 S MAIN ST
Practice Address - Street 2:SUITE 214
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75116-4700
Practice Address - Country:US
Practice Address - Phone:469-407-0381
Practice Address - Fax:972-572-1069
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-01
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY003411103TC1900X
TX36677103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling