Provider Demographics
NPI:1760906267
Name:SHELTON, SIMONE ELLOIE (ED D)
Entity Type:Individual
Prefix:DR
First Name:SIMONE
Middle Name:ELLOIE
Last Name:SHELTON
Suffix:
Gender:F
Credentials:ED D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18291 MANCHAC PLACE DR
Mailing Address - Street 2:
Mailing Address - City:PRAIRIEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70769-3355
Mailing Address - Country:US
Mailing Address - Phone:225-252-3655
Mailing Address - Fax:
Practice Address - Street 1:18291 MANCHAC PLACE DR
Practice Address - Street 2:
Practice Address - City:PRAIRIEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70769-3355
Practice Address - Country:US
Practice Address - Phone:225-252-3655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-27
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA7616101Y00000X, 101YP2500X, 251C00000X, 101YS0200X, 251S00000X, 261QD1600X, 261QM0801X, 101YM0800X
101YM0800X, 171M00000X
LA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No251S00000XAgenciesCommunity/Behavioral Health
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)