Provider Demographics
NPI:1255958815
Name:DALES, SHEKELIA TAIRITHIA (LPC)
Entity type:Individual
Prefix:
First Name:SHEKELIA
Middle Name:TAIRITHIA
Last Name:DALES
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5029 NAUTICAL LN
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76210-0208
Mailing Address - Country:US
Mailing Address - Phone:940-594-5778
Mailing Address - Fax:
Practice Address - Street 1:5029 NAUTICAL LN
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76210-0208
Practice Address - Country:US
Practice Address - Phone:940-594-5778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-30
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX78359101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty