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NPI Code Detail

MEDICARE: ELIZABETH BROKAW SHUSTER LCMHCA

MEDICARE: ELIZABETH BROKAW SHUSTER LCMHCA
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
1101YM0800XMental Health CounselorA19986NC

General Provider Information

NPI Number : 1457192171
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELIZABETH BROKAW SHUSTER LCMHCA
Provider Business Mailing Address
First Line : 6302 FAIRVIEW RD STE 100
Second Line :
City : CHARLOTTE
State : NC
Zip : 28210-2227
Country : US
Telephone Number : 704-584-9897
Fax Number :
Provider Business Practice Location Address
First Line : 6302 FAIRVIEW RD STE 100
Second Line :
City : CHARLOTTE
State : NC
Zip : 28210-2227
Country : US
Telephone Number : 704-584-9897
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/05/2024
Last Update Date : 06/05/2024

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