Healthcare Provider Details

I. General information

NPI: 1760906267
Provider Name (Legal Business Name): SIMONE ELLOIE SHELTON ED. D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2017
Last Update Date: 12/18/2023
Certification Date: 12/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18291 MANCHAC PLACE DR
PRAIRIEVILLE LA
70769-3355
US

IV. Provider business mailing address

18291 MANCHAC PLACE DR
PRAIRIEVILLE LA
70769-3355
US

V. Phone/Fax

Practice location:
  • Phone: 225-252-3655
  • Fax:
Mailing address:
  • Phone: 225-252-3655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number7616
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number7616
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number7616
License Number StateLA
# 4
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number7616
License Number StateLA
# 5
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 6
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number7616
License Number StateLA
# 7
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number7616
License Number StateLA
# 8
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number7616
License Number StateLA
# 9
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateLA
# 10
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 11
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number7616
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: