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NPI Code Detail

MEDICARE: DR. SHA RON JOHNSON LPCC-S, LICDC, EDD

MEDICARE: DR. SHA RON JOHNSON LPCC-S, LICDC, EDD
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
1101YA0400XAddiction (Substance Use Disorder) CounselorLICDC.161974OH
2101YM0800XMental Health CounselorE.1901262-SUPVOH

General Provider Information

NPI Number : 1538576574
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SHA RON JOHNSON LPCC-S, LICDC, EDD
Provider Business Mailing Address
First Line : 10100 ELIDA RD
Second Line :
City : DELPHOS
State : OH
Zip : 45833-9056
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 20600 CHAGRIN BLVD STE 320
Second Line :
City : SHAKER HEIGHTS
State : OH
Zip : 44122-5334
Country : US
Telephone Number : 216-295-7239
Fax Number : 216-295-7240
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/22/2014
Last Update Date : 02/07/2022

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