Active NPI
John Lewis Shelton, PH.D.
- Clinical Psychologist
- Everett, WA
National Provider Identifier
1033153242
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PY00000580
- Practice address
- 3331 Broadway
Everett, WA 98201-4472 - Phone
- (360) 321-1022
- Fax
- (360) 321-4575
- NPI assigned
- Jun 16, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PY00000580 | WA | Primary |
Addresses
Primary practice location
3331 Broadway
Everett, WA 98201-4472
Mailing address
PO Box 744
Freeland, WA 98249-0744
Phone (360) 321-1022
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0017234 | Other | WA | WASHINGTON STATE DEPARTMENT OF LABOR AND INDUSTRIES |
| PY00000580 | Other | WA | PROFESSIONAL LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150416000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1334534400000",
"number": "1033153242",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 744",
"city": "FREELAND",
"state": "WA",
"postal_code": "982490744",
"telephone_number": "360-321-1022",
"fax_number": "360-321-4575"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3331 BROADWAY",
"city": "EVERETT",
"state": "WA",
"postal_code": "982014472",
"telephone_number": "360-321-1022",
"fax_number": "360-321-4575"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHELTON",
"first_name": "JOHN",
"middle_name": "LEWIS",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-06-16",
"last_updated": "2012-04-16",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "WA",
"license": "PY00000580",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WASHINGTON STATE DEPARTMENT OF LABOR AND INDUSTRIES",
"identifier": "0017234",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PROFESSIONAL LICENSE",
"identifier": "PY00000580",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Everett, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.