Provider Demographics
NPI:1770031866
Name:MORTON, SHELETHA M
Entity Type:Individual
Prefix:
First Name:SHELETHA
Middle Name:M
Last Name:MORTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 MOCKINGBIRD ST
Mailing Address - Street 2:
Mailing Address - City:SAINT ROSE
Mailing Address - State:LA
Mailing Address - Zip Code:70087-3816
Mailing Address - Country:US
Mailing Address - Phone:504-205-5353
Mailing Address - Fax:
Practice Address - Street 1:612 MOCKINGBIRD ST
Practice Address - Street 2:
Practice Address - City:SAINT ROSE
Practice Address - State:LA
Practice Address - Zip Code:70087
Practice Address - Country:US
Practice Address - Phone:504-205-5353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-16
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator