Provider Demographics
NPI:1861618050
Name:SHELTREN, CONSTANCE JEAN (PHD)
Entity type:Individual
Prefix:DR
First Name:CONSTANCE
Middle Name:JEAN
Last Name:SHELTREN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:623 W WASHINGTON ST STE A
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89703-3837
Mailing Address - Country:US
Mailing Address - Phone:775-884-3600
Mailing Address - Fax:774-884-3601
Practice Address - Street 1:623 W WASHINGTON ST STE A
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89703-3837
Practice Address - Country:US
Practice Address - Phone:775-884-3600
Practice Address - Fax:774-884-3601
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 25836106H00000X
NVPY0568103TC0700X
CAPSY 22839103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist