Provider Demographics
NPI:1245023878
Name:MONROE, SHELTON BROCK (LCSW)
Entity type:Individual
Prefix:
First Name:SHELTON
Middle Name:BROCK
Last Name:MONROE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 AUDRA LN APT G
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76209-7520
Mailing Address - Country:US
Mailing Address - Phone:325-656-7558
Mailing Address - Fax:
Practice Address - Street 1:10640 N RIVERSIDE DR STE 300
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-9507
Practice Address - Country:US
Practice Address - Phone:817-722-6078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-27
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1069661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty