Healthcare Provider Details

I. General information

NPI: 1568301505
Provider Name (Legal Business Name): SHELBY FLEETWOOD LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

629 LINCOLN AVE
BEDFORD IN
47421-2142
US

IV. Provider business mailing address

PO BOX 270
PAOLI IN
47454-0270
US

V. Phone/Fax

Practice location:
  • Phone: 812-675-4470
  • Fax: 812-675-4469
Mailing address:
  • Phone: 812-723-3944
  • Fax: 812-723-7989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number33011952A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: