Provider Demographics
NPI:1891946851
Name:SHELTON, SUZZETTE M (LCDC)
Entity Type:Individual
Prefix:
First Name:SUZZETTE
Middle Name:M
Last Name:SHELTON
Suffix:
Gender:F
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8509 WESTERN HILLS BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76108-3410
Mailing Address - Country:US
Mailing Address - Phone:817-875-6219
Mailing Address - Fax:817-336-4663
Practice Address - Street 1:8509 WESTERN HILLS BOULEVARD
Practice Address - Street 2:SUITE 200
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76108-3410
Practice Address - Country:US
Practice Address - Phone:817-875-6219
Practice Address - Fax:817-336-4663
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-08
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3523101YA0400X
TX221496163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health