Provider Demographics
NPI:1699835462
Name:SHELLENBERGER, CARRON LOU (LPC)
Entity Type:Individual
Prefix:MS
First Name:CARRON
Middle Name:LOU
Last Name:SHELLENBERGER
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 1:401 E ILLINOIS
Mailing Address - Street 2:STE 400
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79701
Mailing Address - Country:US
Mailing Address - Phone:432-570-3333
Mailing Address - Fax:432-570-3346
Practice Address - Street 1:1111 W 12TH STREET
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79763
Practice Address - Country:US
Practice Address - Phone:432-333-3265
Practice Address - Fax:432-570-3346
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15336101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health