MEDICARE: MRS. CHRISTINE ANITA SHELTON MFT 38626 CA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	MFT 38626	CA

General Provider Information

NPI Number	:	1053506360
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHRISTINE ANITA SHELTON MFT 38626 CA

Provider Business Mailing Address
First Line	:	10378 CAREY DR
Second Line	:
City	:	GRASS VALLEY
State	:	CA
Zip	:	95945-4801
Country	:	US
Telephone Number	:	530-272-0995
Fax Number	:	530-273-1299

Provider Business Practice Location Address
First Line	:	405 W MAIN ST
Second Line	:
City	:	GRASS VALLEY
State	:	CA
Zip	:	95945-6403
Country	:	US
Telephone Number	:	530-272-0995
Fax Number	:	530-273-1299

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/10/2007
Last Update Date	:	04/28/2024

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