Doctor Name: | SUSAN MILLETTE SHELTON |
NPI Number: | 1093094898 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | |
Business Practice Address: | 208 N 2nd St Hugo, OK - 747433854 |
Business Phone Number: | 5803268373 |
Business Fax Number: | |
Mailing Address: | 473 County Road 45250, POWDERLY |
State: | TX |
Postal Code: | 754734316 |
Phone Number: | 9037324728 |
Fax Number: | |
NPI Enumeration Date: | 08/10/2011 |
NPI Last Update Date: | 09/29/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |