Provider Demographics
NPI:1952652836
Name:SHELTON, KEVIN KENT SR
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:KENT
Last Name:SHELTON
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 E HARLOW PL
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73127-2408
Mailing Address - Country:US
Mailing Address - Phone:405-474-1963
Mailing Address - Fax:
Practice Address - Street 1:2120 EAST HARLOW PLACE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73127
Practice Address - Country:US
Practice Address - Phone:405-474-1963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-02
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst