Provider Demographics
NPI:1720411267
Name:SHELTON, JUANICE EVONNE (BS)
Entity Type:Individual
Prefix:MRS
First Name:JUANICE
Middle Name:EVONNE
Last Name:SHELTON
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2013 PLYMOUTH LN
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-4222
Mailing Address - Country:US
Mailing Address - Phone:405-751-3220
Mailing Address - Fax:
Practice Address - Street 1:2013 PLYMOUTH LN
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-4222
Practice Address - Country:US
Practice Address - Phone:405-751-3220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-20
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst