Provider Demographics
NPI:1871845081
Name:CONSTANCE SHELTREN, PH.D.
Entity Type:Organization
Organization Name:CONSTANCE SHELTREN, PH.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CONSTANCE
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:SHELTREN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:775-884-3600
Mailing Address - Street 1:623 W WASHINGTON ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89703-3802
Mailing Address - Country:US
Mailing Address - Phone:775-884-3600
Mailing Address - Fax:775-884-3601
Practice Address - Street 1:623 W WASHINGTON ST
Practice Address - Street 2:SUITE A
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89703-3802
Practice Address - Country:US
Practice Address - Phone:775-884-3600
Practice Address - Fax:775-884-3601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-11
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPY0568103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1861618050OtherNPI
NV1861618050Medicaid