Provider Demographics
NPI:1770671695
Name:SHELTON, KATHRYN RYAN (LCSW)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:RYAN
Last Name:SHELTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 N ROBERTSON BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90048-1732
Mailing Address - Country:US
Mailing Address - Phone:310-435-0012
Mailing Address - Fax:
Practice Address - Street 1:450 N ROBERTSON BLVD
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90048-1732
Practice Address - Country:US
Practice Address - Phone:310-435-0012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA224611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical