Provider Demographics
NPI:1265924112
Name:HINTON, SHENELLE (LCADC, LMFT)
Entity type:Individual
Prefix:
First Name:SHENELLE
Middle Name:
Last Name:HINTON
Suffix:
Gender:F
Credentials:LCADC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7607 FAIR LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40291-8352
Mailing Address - Country:US
Mailing Address - Phone:502-819-3710
Mailing Address - Fax:
Practice Address - Street 1:7607 FAIR LN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40291-8352
Practice Address - Country:US
Practice Address - Phone:502-819-3710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-05
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY172550101YA0400X
KY251B00000X
KY274118106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No251B00000XAgenciesCase Management