Provider Demographics
NPI:1205553435
Name:SHELTON, ANNE MARLENE (PHD)
Entity type:Individual
Prefix:DR
First Name:ANNE
Middle Name:MARLENE
Last Name:SHELTON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26761 SOL CT
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92544-7570
Mailing Address - Country:US
Mailing Address - Phone:760-445-5331
Mailing Address - Fax:
Practice Address - Street 1:334 VIA VERA CRUZ STE 259
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078-2643
Practice Address - Country:US
Practice Address - Phone:760-707-6765
Practice Address - Fax:760-683-5041
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-27
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPBS94025436101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health