1053506360 NPI number — MRS. CHRISTINE ANITA SHELTON MFT 38626 CA

Table of content: MRS. CHRISTINE ANITA SHELTON MFT 38626 CA (NPI 1053506360)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053506360 NPI number — MRS. CHRISTINE ANITA SHELTON MFT 38626 CA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHELTON
Provider First Name:
CHRISTINE
Provider Middle Name:
ANITA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MFT 38626 CA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SHELTON
Provider Other First Name:
CHRISTINE
Provider Other Middle Name:
ANITA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MS
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1053506360
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/28/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10378 CAREY DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRASS VALLEY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95945-4801
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-272-0995
Provider Business Mailing Address Fax Number:
530-273-1299

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
405 W MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRASS VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95945-6403
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-272-0995
Provider Business Practice Location Address Fax Number:
530-273-1299
Provider Enumeration Date:
09/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  MFT 38626 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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