=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194543132
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAVID SHELTON LMFT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/30/2024
-----------------------------------------------------
Last Update Date | 12/17/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 400 TECHNOLOGY CT SE STE J
-----------------------------------------------------
City | SMYRNA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30082-5237
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-431-2354
-----------------------------------------------------
Fax | 770-436-7143
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 400 TECHNOLOGY CT SE STE J
-----------------------------------------------------
City | SMYRNA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30082-5237
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-431-2354
-----------------------------------------------------
Fax | 770-436-7143
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | MFT002136
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------