Provider Demographics
NPI:1881219319
Name:SHELBY, ASHTON BRIAUNA (PHD)
Entity type:Individual
Prefix:
First Name:ASHTON
Middle Name:BRIAUNA
Last Name:SHELBY
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 1:4115 LANIE DR
Mailing Address - Street 2:
Mailing Address - City:KEVIL
Mailing Address - State:KY
Mailing Address - Zip Code:42053-9327
Mailing Address - Country:US
Mailing Address - Phone:618-727-1913
Mailing Address - Fax:
Practice Address - Street 1:413 BROADWAY ST STE A
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-0738
Practice Address - Country:US
Practice Address - Phone:618-727-1913
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-10
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
KY243869103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist