Individual
MR. MARK JIM SHELTON
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
100 S 1000 W, TOOELE, UT 84074-4010
(435) 843-3520
(435) 843-3555
Mailing address
355 CHAMPLAINE ST., TOOELE, UT 84074
(435) 882-8552
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
128877-3501
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
107000925101
INTERMOUNTAIN HEALTH CARE
UT
01
—
292738
DESERET MUTUAL
UT
01
—
942938348006
CHAMPUS
UT
01
—
942938348SH1
EDUCATOR'S MUTUAL
UT
01
—
R95603
ICAR
UT
Enumeration date
02/01/2006
Last updated
07/09/2007
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