Provider Demographics
NPI:1770772097
Name:SHELTON, EBONY (LMSW)
Entity type:Individual
Prefix:
First Name:EBONY
Middle Name:
Last Name:SHELTON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:EBONY
Other - Middle Name:MONIQUE
Other - Last Name:SHELTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMSW
Mailing Address - Street 1:9002 CHIMNEY ROCK RD STE G238
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77096-2509
Mailing Address - Country:US
Mailing Address - Phone:281-714-0885
Mailing Address - Fax:832-209-8011
Practice Address - Street 1:9406 WINNWOOD CT
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-5097
Practice Address - Country:US
Practice Address - Phone:281-714-0885
Practice Address - Fax:832-209-8011
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-23
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM0850X
TX2016-049364-001B261QM0850X
TX60555104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker