Healthcare Provider Details

I. General information

NPI: 1851888226
Provider Name (Legal Business Name): HELEN SHELTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2018
Last Update Date: 08/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3115 SUNSET BLVD
WEST COLUMBIA SC
29169-3425
US

IV. Provider business mailing address

1321 MURFRESBORO PIKE
NASHVILLE TN
37217-2626
US

V. Phone/Fax

Practice location:
  • Phone: 803-791-3722
  • Fax:
Mailing address:
  • Phone: 803-905-4427
  • Fax: 615-577-5661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-18-310000
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: