Provider Demographics
NPI:1811321953
Name:SHELTON, BRANDI MARIE (LBSW)
Entity type:Individual
Prefix:
First Name:BRANDI
Middle Name:MARIE
Last Name:SHELTON
Suffix:
Gender:F
Credentials:LBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9268 S HAWKINS RD
Mailing Address - Street 2:
Mailing Address - City:REED CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49677-8702
Mailing Address - Country:US
Mailing Address - Phone:231-250-7902
Mailing Address - Fax:
Practice Address - Street 1:500 S 3RD AVE
Practice Address - Street 2:
Practice Address - City:BIG RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49307-9501
Practice Address - Country:US
Practice Address - Phone:231-796-5825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-26
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802085148104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker