Healthcare Provider Details

I. General information

NPI: 1659018059
Provider Name (Legal Business Name): SHOALEH DJEBELLI LMHC, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2022
Last Update Date: 05/17/2022
Certification Date: 05/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16950 N BAY RD APT 1610
SUNNY ISLES BEACH FL
33160-4246
US

IV. Provider business mailing address

16950 N BAY RD APT 1610
SUNNY ISLES BEACH FL
33160-4246
US

V. Phone/Fax

Practice location:
  • Phone: 469-735-3083
  • Fax:
Mailing address:
  • Phone: 469-735-3083
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: