Provider Demographics
NPI:1548522816
Name:SHELTON, BETH (MA)
Entity type:Individual
Prefix:MRS
First Name:BETH
Middle Name:
Last Name:SHELTON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 NORTH CONVENT
Mailing Address - Street 2:
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914-1332
Mailing Address - Country:US
Mailing Address - Phone:815-260-1453
Mailing Address - Fax:815-602-8205
Practice Address - Street 1:650 NORTH CONVENT
Practice Address - Street 2:
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-1332
Practice Address - Country:US
Practice Address - Phone:815-260-1453
Practice Address - Fax:815-602-8505
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-13
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health