MEDICARE: SUSAN SHELBY LAWYER LCPC

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	101YP2500X	Professional Counselor	LC11309	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	NON	OTHER	MD	NON

General Provider Information

NPI Number	:	1508427816
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN SHELBY LAWYER LCPC

Provider Business Mailing Address
First Line	:	1812 BALTIMORE BLVD STE C
Second Line	:
City	:	WESTMINSTER
State	:	MD
Zip	:	21157-7144
Country	:	US
Telephone Number	:	443-398-4649
Fax Number	:

Provider Business Practice Location Address
First Line	:	1812 BALTIMORE BLVD STE C
Second Line	:
City	:	WESTMINSTER
State	:	MD
Zip	:	21157-7144
Country	:	US
Telephone Number	:	443-398-4649
Fax Number	:

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

Provider Enumeration Date	:	06/26/2019
Last Update Date	:	09/28/2021

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