Provider Demographics
NPI:1750769592
Name:SHELTON, EMILY (LCPC, LAC)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:SHELTON
Suffix:
Gender:F
Credentials:LCPC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:914 20TH ST S
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405-2743
Mailing Address - Country:US
Mailing Address - Phone:406-217-6007
Mailing Address - Fax:855-873-1194
Practice Address - Street 1:914 20TH ST S
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-2743
Practice Address - Country:US
Practice Address - Phone:406-217-6007
Practice Address - Fax:855-873-1194
Is Sole Proprietor?:No
Enumeration Date:2015-05-13
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTLAC-LAC-LIC-4139101YA0400X
MTSWP-LCPC-LIC-11066101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT813076483Medicaid