Provider Demographics
NPI:1104428663
Name:SHELTON, LESLIE (MA LPC)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:SHELTON
Suffix:
Gender:F
Credentials:MA LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3222 E 1ST AVE SUITE 627
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-5854
Mailing Address - Country:US
Mailing Address - Phone:214-298-5552
Mailing Address - Fax:
Practice Address - Street 1:3222 E. 1ST AVE. SUITE 627
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-5854
Practice Address - Country:US
Practice Address - Phone:214-298-5552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-10
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC0016315101YM0800X, 101YP2500X
TX18398101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health