Healthcare Provider Details

I. General information

NPI: 1053506360
Provider Name (Legal Business Name): CHRISTINE ANITA SHELTON MFT 38626 CA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHRISTINE ANITA SHELTON MS

II. Dates (important events)

Enumeration Date: 09/10/2007
Last Update Date: 04/28/2024
Certification Date: 04/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 W MAIN ST
GRASS VALLEY CA
95945-6403
US

IV. Provider business mailing address

10378 CAREY DR
GRASS VALLEY CA
95945-4801
US

V. Phone/Fax

Practice location:
  • Phone: 530-272-0995
  • Fax: 530-273-1299
Mailing address:
  • Phone: 530-272-0995
  • Fax: 530-273-1299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMFT 38626
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: