Provider Demographics
NPI:1538735626
Name:SHELTON, JADE MICHELLE (LIAC)
Entity type:Individual
Prefix:
First Name:JADE
Middle Name:MICHELLE
Last Name:SHELTON
Suffix:
Gender:F
Credentials:LIAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 N CENTRAL AVE FL 18
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-2322
Mailing Address - Country:US
Mailing Address - Phone:646-941-7645
Mailing Address - Fax:
Practice Address - Street 1:2 N CENTRAL AVE FL 18
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-2322
Practice Address - Country:US
Practice Address - Phone:646-941-7645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-31
Last Update Date:2025-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ155390101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)