Provider Demographics
NPI:1952471286
Name:SHELTON, PATRICIA (LPC11100)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:
Last Name:SHELTON
Suffix:
Gender:F
Credentials:LPC11100
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2017 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-2102
Mailing Address - Country:US
Mailing Address - Phone:602-452-4684
Mailing Address - Fax:602-358-0399
Practice Address - Street 1:1930 S ALMA SCHOOL RD
Practice Address - Street 2:SUITE A104
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-3064
Practice Address - Country:US
Practice Address - Phone:480-820-0825
Practice Address - Fax:480-820-7863
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC11100101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZLPC11100OtherTHERAPIST