Provider Demographics
NPI:1871258293
Name:SHELTON, SETH (PLMHP)
Entity Type:Individual
Prefix:
First Name:SETH
Middle Name:
Last Name:SHELTON
Suffix:
Gender:M
Credentials:PLMHP
Other - Prefix:
Other - First Name:SETH
Other - Middle Name:
Other - Last Name:NOENNIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1331 G ST # 206
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68508-3707
Mailing Address - Country:US
Mailing Address - Phone:402-560-6609
Mailing Address - Fax:
Practice Address - Street 1:1620 S 70TH ST STE 105
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-1563
Practice Address - Country:US
Practice Address - Phone:402-853-2396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-01
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE12811101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health