Healthcare Provider Details

I. General information

NPI: 1053241083
Provider Name (Legal Business Name): NICKEDA D SHELTON LPC, NCC,NCSC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 ANN CIR
TUPELO MS
38801-6447
US

IV. Provider business mailing address

106 ANN CIR
TUPELO MS
38801-6447
US

V. Phone/Fax

Practice location:
  • Phone: 662-790-3283
  • Fax:
Mailing address:
  • Phone: 662-790-3283
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number858
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: