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General NPI Number Information
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NPI Number | 1245023878
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Entity Type | Individual
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Provider Name | SHELTON BROCK MONROE LCSW
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Gender | Male
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Dates
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Enumeration Date | 05/27/2025
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Last Update Date | 05/27/2025
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Provider Practice Location Address
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Address Line | 10640 N RIVERSIDE DR STE 300
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City | FORT WORTH
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State | TX
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Zip | 76244-9507
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Country | US
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Telephone | 817-722-6078
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Fax |
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Provider Business Mailing Address
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Address Line | 318 AUDRA LN APT G
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City | DENTON
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State | TX
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Zip | 76209-7520
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Country | US
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Telephone | 325-656-7558
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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 | 106966
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License Number State | TX
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