Provider Demographics
NPI:1881489268
Name:SHELTON, AUTUMN SIMONE (LLPC)
Entity type:Individual
Prefix:
First Name:AUTUMN
Middle Name:SIMONE
Last Name:SHELTON
Suffix:
Gender:
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2911 W GRAND BLVD APT 4124
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-2678
Mailing Address - Country:US
Mailing Address - Phone:313-285-7639
Mailing Address - Fax:
Practice Address - Street 1:1010 ANTIETAM AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48207-2832
Practice Address - Country:US
Practice Address - Phone:313-474-1711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-14
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6451024133101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health