Lisa Patrice Shelton, MS

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

S15221 Issued in NC

Practice address

250 Executive Park Blvd Ste 120
Winston Salem, NC 27103-1534

Phone

(336) 770-2477

NPI assigned

Apr 15, 2008

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 6

Addresses

Other identifiers 1

Other names 1

• Lisa P Shelton Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Consulting & Evaluation Services, Inc.

  • Community/Behavioral Health Agency
  • Greensboro, NC
  • NPI 1295596799
  NPD Authorized official
• Crossroads Treatment Center of Greensboro, PC

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Greensboro, NC
  • NPI 1245482793
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1208217600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1679356800000",
    "number": "1104090745",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "132 QUEENSBERRY CT",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274054899",
            "telephone_number": "224-735-1210"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 EXECUTIVE PARK BLVD STE 120",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271031534",
            "telephone_number": "336-770-2477"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1132 N Church St",
            "address_purpose": "LOCATION",
            "city": "Greensboro",
            "state": "NC",
            "postal_code": "274011039",
            "country_code": "US",
            "telephone_number": "877-876-3783",
            "fax_number": "855-420-6402",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "132 Queensberry Ct",
            "address_purpose": "LOCATION",
            "city": "Greensboro",
            "state": "NC",
            "postal_code": "274054899",
            "country_code": "US",
            "telephone_number": "224-735-1210",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHELTON",
        "first_name": "LISA",
        "middle_name": "PATRICE",
        "credential": "MS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-04-15",
        "last_updated": "2023-03-21",
        "certification_date": "2023-03-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "IL",
            "license": "17438",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NC",
            "license": "25760",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NC",
            "license": "15221",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "180.008438",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "IL",
            "license": "180.008438",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NC",
            "license": "S15221",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "39168700",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LISA",
            "last_name": "SHELTON",
            "middle_name": "P",
            "credential": "MS, LCPC, CAADC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Shelton Movement and Performance
• Bradford Tyler Shelton, DPT
• Burton Otis Shelton, FNP C
• Hunter Gabel Shelton, DO
• Ivory Janee' Shelton, M.D.
• Megan Montgomery Shelton, PNP
• Joan Shen, MD
• Perry Shen, MD
• Yaoyun Sarah Shen, MD
• Bryson Shepherd

• Mental Health Counselor in Winston Salem, NC
• Providers in Winston Salem, NC by specialty
• Mental Health Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.