Provider Demographics
NPI:1396147096
Name:SHELTON, HEATHER ANN (LCPC)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:ANN
Last Name:SHELTON
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:A
Other - Last Name:WHEELER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCPC
Mailing Address - Street 1:2810 W CORNELISON ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67203-2027
Mailing Address - Country:US
Mailing Address - Phone:316-259-1364
Mailing Address - Fax:316-348-8386
Practice Address - Street 1:1999 N AMIDON AVE STE 365
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-2160
Practice Address - Country:US
Practice Address - Phone:316-285-9154
Practice Address - Fax:316-348-8386
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-24
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2476101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201104170AMedicaid