Provider Demographics
NPI:1598936197
Name:SHELTON, DIANE ISABELLE (LMFT, LCPC, LPC)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:ISABELLE
Last Name:SHELTON
Suffix:
Gender:F
Credentials:LMFT, LCPC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 GOLF CTR # 388
Mailing Address - Street 2:
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60169-4910
Mailing Address - Country:US
Mailing Address - Phone:847-594-7447
Mailing Address - Fax:847-745-0658
Practice Address - Street 1:21 N SKOKIE HWY
Practice Address - Street 2:SUITE 203
Practice Address - City:LAKE BLUFF
Practice Address - State:IL
Practice Address - Zip Code:60044-1777
Practice Address - Country:US
Practice Address - Phone:847-594-7447
Practice Address - Fax:847-745-0658
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-22
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-006091101YP2500X
NC4882101YP2500X
WI3552-125101YP2500X
IL166-000921106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional