MEDICARE: KELLI M SHANKLIN LPC

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	101YM0800X	Mental Health Counselor	C.1000593-TRNE	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841596020
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLI M SHANKLIN LPC

Provider Business Mailing Address
First Line	:	3618 LINDHOLM RD
Second Line	:
City	:	SHAKER HEIGHTS
State	:	OH
Zip	:	44120-5127
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3618 LINDHOLM RD
Second Line	:
City	:	SHAKER HEIGHTS
State	:	OH
Zip	:	44120-5127
Country	:	US
Telephone Number	:	216-752-0490
Fax Number	:

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

Provider Enumeration Date	:	02/04/2011
Last Update Date	:	02/21/2018

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Directions to “ KELLI M SHANKLIN LPC” Practice Location

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