Doctor Name: | SHANTELE H LEDOUX |
NPI Number: | 1427483692 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.ED. |
License Number: | |
Business Practice Address: | 439 Breeze St Ste 200 Craig, CO - 816252650 |
Business Phone Number: | 9708246541 |
Business Fax Number: | 9708240313 |
Mailing Address: | 715 Horizon Dr, Ste 225 GRAND JUNCTION |
State: | CO |
Postal Code: | 815068700 |
Phone Number: | 9706837107 |
Fax Number: | 9706837167 |
NPI Enumeration Date: | 09/06/2013 |
NPI Last Update Date: | 09/06/2013 |
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: |