Provider Demographics
NPI:1972030476
Name:SHELTON, LORRENE LOUISE (LPC)
Entity type:Individual
Prefix:
First Name:LORRENE
Middle Name:LOUISE
Last Name:SHELTON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:LORRENE
Other - Middle Name:LOUISE
Other - Last Name:SHELTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:7235 RIVER RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:PONCA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74604-7209
Mailing Address - Country:US
Mailing Address - Phone:580-401-9365
Mailing Address - Fax:580-215-5765
Practice Address - Street 1:7235 RIVER RIDGE DR
Practice Address - Street 2:
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74604-7209
Practice Address - Country:US
Practice Address - Phone:580-401-9345
Practice Address - Fax:580-215-5765
Is Sole Proprietor?:No
Enumeration Date:2017-05-15
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
OK10205101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator