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General NPI Number Information
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NPI Number | 1922343920
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Entity Type | Individual
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Provider Name | HUNTLY ELBERTO SHELTON III PH.D.
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Gender | Male
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Dates
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Enumeration Date | 12/01/2012
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Last Update Date | 12/01/2012
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Provider Practice Location Address
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Address Line | 3840 HULEN ST SUITE 105
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City | FORT WORTH
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State | TX
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Zip | 76107-7277
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Country | US
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Telephone | 817-732-8561
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Fax | 817-732-8561
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Provider Business Mailing Address
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Address Line | 3840 HULEN ST SUITE 105
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City | FORT WORTH
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State | TX
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Zip | 76107-7277
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Country | US
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Telephone | 817-732-8561
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Fax | 817-732-8561
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 4154
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 12050
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License Number State | TX
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