Provider Demographics
NPI:1619266657
Name:SHACKELFORD, NATHAN KARL (MSW, LSW, MPA)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:KARL
Last Name:SHACKELFORD
Suffix:
Gender:M
Credentials:MSW, LSW, MPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401-5719
Mailing Address - Country:US
Mailing Address - Phone:970-240-3208
Mailing Address - Fax:970-240-3211
Practice Address - Street 1:314 S 6TH ST
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-5719
Practice Address - Country:US
Practice Address - Phone:970-240-3208
Practice Address - Fax:970-240-3211
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-30
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO816104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker