Mark Jim Shelton is a Clinical in Tooele, Utah. Mark Jim Shelton practices all healthcare services and medical treatments related to Clinical. The NPI Number for Mark Jim Shelton is 1770554289. The last update date is 2007-07-09.
Mark Jim Shelton's current location address is 355 Champlaine St., Tooele, Utah. You can contact this provider via phone number 4358828552. The mailing address for Mark Jim Shelton is 355 Champlaine St., Tooele, Utah. To know further, please read the information below!
Provider Profile Detail
| Provider Name | Mark Jim Shelton |
|---|---|
| Address | 355 Champlaine St., Tooele, Utah |
| Phone Number | 4358828552 |
| Fax Number | |
| Sole Proprietor | X |
| Credentials | LCSW |
NPI Number Detail
| NPI Number | 1770554289 |
|---|---|
| Provider Enumeration Date | 2006-02-01 |
| Last Updated Date | 2007-07-09 |
Provider Mailing Address Detail
| Address | 355 Champlaine St. |
|---|---|
| City | Tooele |
| State | Utah (UT) |
| Post Code | 84074 |
| Phone Number | 4358828552 |
| Fax Number |
Provider's Primary Taxonomy Detail
| Speciality | Clinical |
|---|---|
| Taxonomy | 1041C0700X |
| Licence No | 128877-3501 |
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Definition: A social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certif |
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Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| 942938348006 | UT | CHAMPUS | |
| R95603 | UT | ICAR | |
| 107000925101 | UT | INTERMOUNTAIN HEALTH CARE | |
| 942938348SH1 | UT | EDUCATOR'S MUTUAL | |
| 292738 | UT | DESERET MUTUAL |
Post Comment/ Review Below
What is the unique 10-digit identifier code assigned to Mark Jim Shelton by the Centers for Medicare & Medicaid Services?
The Mark Jim Shelton has been issued the NPI (National Provider Identifier) 1770554289 by the CMS (Centers for Medicare & Medicaid Services), which serves as a unique identification number for healthcare providers.
Could you provide the complete physical address where Mark Jim Shelton is located?
The Mark Jim Shelton is situated at the following address: 355 Champlaine St., Tooele, UT, 84074.
What is the Mark Jim Shelton's specialty and taxonomy code?
The Mark Jim Shelton's specialty is Clinical, and the corresponding taxonomy code is 1041C0700X.
On what date did the Centers for Medicare & Medicaid Services originally issue the 1770554289 to Mark Jim Shelton?
The Centers for Medicare & Medicaid Services originally issued the 1770554289 to Mark Jim Shelton on 2006-02-01.
As of what date were the details pertaining to Mark Jim Shelton last refreshed?
The information related to the Mark Jim Shelton, including its address, specialty, and other relevant details, was last updated on 2007-07-09.
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