Provider Demographics
NPI:1629480520
Name:SHELTON, SALINA (LPC)
Entity Type:Individual
Prefix:
First Name:SALINA
Middle Name:
Last Name:SHELTON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:980 TALLEY RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78253-5228
Mailing Address - Country:US
Mailing Address - Phone:210-617-3185
Mailing Address - Fax:
Practice Address - Street 1:980 TALLEY RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78253-5228
Practice Address - Country:US
Practice Address - Phone:210-617-3185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-27
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 101YP2500X
TX72293101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX352921602OtherTEXAS PROVIDER IDENTIFICATION
TX397040201Medicaid
TX352921602Medicaid
TX352921601Medicaid