Healthcare Provider Details

I. General information

NPI: 1356021133
Provider Name (Legal Business Name): SHELTON FAMILY THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2023
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16888 NISQUALLI RD STE 200
VICTORVILLE CA
92395-9703
US

IV. Provider business mailing address

16888 NISQUALLI RD
VICTORVILLE CA
92395-9703
US

V. Phone/Fax

Practice location:
  • Phone: 951-529-9039
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: MACIE TAYLOR SHELTON
Title or Position: OWNER
Credential: LMFT
Phone: 951-529-9039