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General NPI Number Information
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NPI Number | 1003953357
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Entity Type | Individual
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Provider Name | MARIE T SHELTON
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Gender | Female
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Dates
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Enumeration Date | 01/30/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4425 JEFFERSON AVE SUITE 106
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City | TEXARKANA
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State | AR
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Zip | 71854-1535
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Country | US
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Telephone | 870-216-1700
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Fax | 870-772-5965
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Provider Business Mailing Address
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Address Line | 4915 TEXAS HIGHWAY 43
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City | BIVINS
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State | TX
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Zip | 75555-2053
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Country | US
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Telephone | 903-796-4749
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 1349C
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 02075
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License Number State | TX
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