Provider Demographics
NPI:1902244361
Name:SHELTON, AMELIA LOUISE (MA, CRC, LPC)
Entity Type:Individual
Prefix:
First Name:AMELIA
Middle Name:LOUISE
Last Name:SHELTON
Suffix:
Gender:F
Credentials:MA, CRC, LPC
Other - Prefix:
Other - First Name:AMELIA
Other - Middle Name:LOUISE
Other - Last Name:MCCLOSKEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3960 PATIENT CARE WAY
Mailing Address - Street 2:STE. 104
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48911-4275
Mailing Address - Country:US
Mailing Address - Phone:517-887-9801
Mailing Address - Fax:517-887-9826
Practice Address - Street 1:3960 PATIENT CARE WAY
Practice Address - Street 2:STE. 104
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48911-4275
Practice Address - Country:US
Practice Address - Phone:517-887-9801
Practice Address - Fax:517-887-9826
Is Sole Proprietor?:No
Enumeration Date:2013-06-07
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401008798101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional