Provider Demographics
NPI:1144891581
Name:SHELTON, EMILY C (CADC, CRSS)
Entity type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:C
Last Name:SHELTON
Suffix:
Gender:F
Credentials:CADC, CRSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5460 MEADOW AVE
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:IN
Mailing Address - Zip Code:46368-3347
Mailing Address - Country:US
Mailing Address - Phone:708-897-3593
Mailing Address - Fax:
Practice Address - Street 1:5460 MEADOW AVE
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:IN
Practice Address - Zip Code:46368-3347
Practice Address - Country:US
Practice Address - Phone:708-897-3593
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-07
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional