Provider Demographics
NPI:1881399582
Name:SHELTON, MADISON
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:SHELTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7509 CHARLESTOWN PIKE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:47111-9623
Mailing Address - Country:US
Mailing Address - Phone:812-653-4009
Mailing Address - Fax:
Practice Address - Street 1:1901 N MORGAN RD
Practice Address - Street 2:
Practice Address - City:TASWELL
Practice Address - State:IN
Practice Address - Zip Code:47175-7204
Practice Address - Country:US
Practice Address - Phone:812-653-4009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-03
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)