Provider Demographics
NPI:1932710472
Name:SHELTON, TAMMIE LEE (LPC-S)
Entity Type:Individual
Prefix:
First Name:TAMMIE
Middle Name:LEE
Last Name:SHELTON
Suffix:
Gender:F
Credentials:LPC-S
Other - Prefix:
Other - First Name:TAMARA
Other - Middle Name:FULLER
Other - Last Name:SHELTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:12932 SMOKEY RANCH DR
Mailing Address - Street 2:
Mailing Address - City:HASLET
Mailing Address - State:TX
Mailing Address - Zip Code:76052-3566
Mailing Address - Country:US
Mailing Address - Phone:817-808-6530
Mailing Address - Fax:
Practice Address - Street 1:1090 SCHOOLHOUSE RD STE 700
Practice Address - Street 2:
Practice Address - City:HASLET
Practice Address - State:TX
Practice Address - Zip Code:76052-3778
Practice Address - Country:US
Practice Address - Phone:817-808-6530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-10
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX68984101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional