Provider Demographics
NPI:1205160967
Name:SHELTON, GAYLE LYNN (LMSW)
Entity type:Individual
Prefix:MS
First Name:GAYLE
Middle Name:LYNN
Last Name:SHELTON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 N MARKET ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67202-2010
Mailing Address - Country:US
Mailing Address - Phone:316-425-6132
Mailing Address - Fax:316-425-6176
Practice Address - Street 1:350 N MARKET ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67202-2010
Practice Address - Country:US
Practice Address - Phone:316-425-6132
Practice Address - Fax:316-425-6176
Is Sole Proprietor?:No
Enumeration Date:2009-09-29
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS6112104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker