Marvin Shelton, ED.S, ED.D, RSAP

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Practice address

6110 Howdershell Rd
Hazelwood, MO 63042-1170

Phone

(314) 942-9499

NPI assigned

Sep 20, 2016

Sex

Male

Sole proprietor

Yes

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Celebrationpointe

  • Community Health Clinic/Center
  • Hazelwood, MO
  • NPI 1073099404

  Addiction (Substance Use Disorder)

  NPD Authorized official
• Celebrationpointe

  • Comprehensive Outpatient Rehabilitation Facility (CORF)
  • Hazelwood, MO
  • NPI 1568010346

  Mental Health (Including Community Mental Health Center)

  NPD Authorized official
• Equilibrium Ranch

  • Assisted Living Facility (Mental Illness)
  • Cuba, MO
  • NPI 1285398024

  Case Manager/Care Coordinator

  NPD

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Sep 19, 2019.

{
    "created_epoch": "1474329600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1568851200000",
    "number": "1003364969",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4166 LINDELL BLVD APT 1B",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631082923",
            "telephone_number": "314-580-3029"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6110 HOWDERSHELL RD",
            "city": "HAZELWOOD",
            "state": "MO",
            "postal_code": "630421170",
            "telephone_number": "314-942-9499"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4166 Lindell Blvd",
            "address_2": "SUITE 1B",
            "address_purpose": "LOCATION",
            "city": "Saint Louis",
            "state": "MO",
            "postal_code": "631082945",
            "country_code": "US",
            "telephone_number": "314-580-3029",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHELTON",
        "first_name": "MARVIN",
        "name_prefix": "Dr.",
        "credential": "ED.S, ED.D, RSAP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-09-20",
        "last_updated": "2019-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MO",
            "license": "9374",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MO",
            "license": "9374",
            "primary": false
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "drms.tcchs@gmail.com",
            "affiliation": "N",
            "endpointDescription": "North County Office",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "6110 Howdershell Rd",
            "city": "Hazelwood",
            "state": "MO",
            "country_code": "US",
            "postal_code": "630421170",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Blake B. Setien, DDS
• Brent B Setien, DDS
• Michelle Brianne Shaffer, PHARM.D.
• Kyle P Shapiro, DDS
• Julie Ann Shelton, NP-C
• Angela Nicole Shields
• Skin Pathology LLC
• Cynthia Michelle Smith
• Emily Rose Smith
• Sonshine Adult Day Care Services LLC

• All providers in Hazelwood, MO
• Clinic/Center in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.