MEDICARE: GWENDOLYN SHELTON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1780537118
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GWENDOLYN SHELTON

Provider Business Mailing Address
First Line	:	501 DARBY CREEK RD STE 1
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40509-1605
Country	:	US
Telephone Number	:	270-929-3386
Fax Number	:

Provider Business Practice Location Address
First Line	:	501 DARBY CREEK RD STE 1
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40509-1605
Country	:	US
Telephone Number	:	270-929-3386
Fax Number	:

Authorized Official
Title or Position	:	LICENSED CLINICAL SOCIAL WORKER
Name	:	GWENDOLYN SHELTON
Credential	:	LCSW
Telephone Number	:	270-929-3386

Provider Enumeration Date	:	02/16/2026
Last Update Date	:	02/16/2026

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