Provider Demographics
NPI:1043342389
Name:SKELTON, LORETTA MAE (PLPC)
Entity type:Individual
Prefix:
First Name:LORETTA
Middle Name:MAE
Last Name:SKELTON
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 612
Mailing Address - Street 2:
Mailing Address - City:LAKE OZARK
Mailing Address - State:MO
Mailing Address - Zip Code:65049-0612
Mailing Address - Country:US
Mailing Address - Phone:573-216-2216
Mailing Address - Fax:573-348-9975
Practice Address - Street 1:5740 HIGHWAY 54
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:OSAGE BEACH
Practice Address - State:MO
Practice Address - Zip Code:65065-3086
Practice Address - Country:US
Practice Address - Phone:573-348-9979
Practice Address - Fax:573-348-9975
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007002489101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional