Individual
DR. MARVIN SHELTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ED.S, ED.D, RSAP
Contact information
Practice address
6110 HOWDERSHELL RD, HAZELWOOD, MO 63042-1170
(314) 942-9499
Mailing address
4166 LINDELL BLVD APT 1B, SAINT LOUIS, MO 63108-2923
(314) 580-3029
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
9374
MO
101YP2500X
Professional Counselor
9374
MO
171M00000X
Case Manager/Care Coordinator
—
—
261Q00000X
Clinic/Center
Primary
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
Other
Enumeration date
09/20/2016
Last updated
09/19/2019
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