Provider Demographics
NPI:1942026224
Name:SHELTON, JESSICA DANIELLE (AMFT)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:DANIELLE
Last Name:SHELTON
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:JESSI
Other - Middle Name:DANIELLE
Other - Last Name:SHELTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1121 LARRY ST
Mailing Address - Street 2:
Mailing Address - City:ARCATA
Mailing Address - State:CA
Mailing Address - Zip Code:95521-5440
Mailing Address - Country:US
Mailing Address - Phone:916-742-2077
Mailing Address - Fax:
Practice Address - Street 1:991 10TH ST
Practice Address - Street 2:
Practice Address - City:ARCATA
Practice Address - State:CA
Practice Address - Zip Code:95521-6114
Practice Address - Country:US
Practice Address - Phone:707-296-9295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-02
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA146783101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA146783OtherBOARD OF BEHAVIORAL SCIENCES