Provider Demographics
NPI:1952627234
Name:SHELTON, ANGELA RENEE (MS, CSW, LPC-TR)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:RENEE
Last Name:SHELTON
Suffix:
Gender:F
Credentials:MS, CSW, LPC-TR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7023 W TALLMADGE CT
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53218-3953
Mailing Address - Country:US
Mailing Address - Phone:414-462-4841
Mailing Address - Fax:
Practice Address - Street 1:7023 W. TALLMADGE CT.
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53218
Practice Address - Country:US
Practice Address - Phone:414-462-4841
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-12
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI237-226101YP2500X
WI9357-120104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No104100000XBehavioral Health & Social Service ProvidersSocial Worker