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General NPI Number Information
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NPI Number | 1225923758
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Entity Type | Individual
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Provider Name | THADDEUS ALTON SHELTON JR. LMFT 03720
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Gender | Male
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Dates
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Enumeration Date | 06/12/2025
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Last Update Date | 06/12/2025
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Provider Practice Location Address
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Address Line | 1601 W 4TH ST
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City | COFFEYVILLE
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State | KS
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Zip | 67337-3333
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Country | US
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Telephone | 620-251-8180
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Fax | 620-251-7400
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Provider Business Mailing Address
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Address Line | PO BOX 688
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City | INDEPENDENCE
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State | KS
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Zip | 67301-0688
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Country | US
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Telephone | 620-331-1748
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 03720
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License Number State | KS
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