MEDICARE: GWENDOLYN RENEE HELTON LPCC-S, LCDC III

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	LCDCIII.976137	OH
2	101YM0800X	Mental Health Counselor	E.0007780-SUPV	OH

General Provider Information

NPI Number	:	1841977592
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GWENDOLYN RENEE HELTON LPCC-S, LCDC III

Provider Business Mailing Address
First Line	:	1112 CRESTWOOD HILLS DR
Second Line	:
City	:	VANDALIA
State	:	OH
Zip	:	45377-2715
Country	:	US
Telephone Number	:	937-478-8150
Fax Number	:

Provider Business Practice Location Address
First Line	:	1112 CRESTWOOD HILLS DR
Second Line	:
City	:	VANDALIA
State	:	OH
Zip	:	45377-2715
Country	:	US
Telephone Number	:	937-478-8150
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/03/2023
Last Update Date	:	07/03/2023

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