MEDICARE: WENDY E. SHOUSE LMFT

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	106H00000X	Marriage & Family Therapist	1121	NC

General Provider Information

NPI Number	:	1902097116
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WENDY E. SHOUSE LMFT

Provider Business Mailing Address
First Line	:	PO BOX 751069
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28275-1069
Country	:	US
Telephone Number	:	252-744-3258
Fax Number	:	252-744-3194

Provider Business Practice Location Address
First Line	:	1015 WH SMITH BLVD
Second Line	:
City	:	GREENVILLE
State	:	NC
Zip	:	27834-5052
Country	:	US
Telephone Number	:	252-816-5150
Fax Number	:	252-816-5151

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

Provider Enumeration Date	:	08/05/2007
Last Update Date	:	12/16/2025

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