Provider Demographics
NPI:1912305863
Name:SHELLER, KRISTEN MARY (LMSW)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:MARY
Last Name:SHELLER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:MARY
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMSW
Mailing Address - Street 1:1215 E. COURT ST
Mailing Address - Street 2:
Mailing Address - City:SEGUIN
Mailing Address - State:TX
Mailing Address - Zip Code:78155-3604
Mailing Address - Country:US
Mailing Address - Phone:830-401-7367
Mailing Address - Fax:830-372-5858
Practice Address - Street 1:1215 E. COURT ST
Practice Address - Street 2:
Practice Address - City:SEGUIN
Practice Address - State:TX
Practice Address - Zip Code:78155-3604
Practice Address - Country:US
Practice Address - Phone:830-401-7367
Practice Address - Fax:830-372-5858
Is Sole Proprietor?:No
Enumeration Date:2014-12-09
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX57160101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor