Healthcare Provider Details

I. General information

NPI: 1659063766
Provider Name (Legal Business Name): SHAYLA HUMBLES LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2023
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 3524
PEORIA IL
61612
US

IV. Provider business mailing address

13266 MIDDLEWOOD LN
FISHERS IN
46038-5835
US

V. Phone/Fax

Practice location:
  • Phone: 317-434-4114
  • Fax:
Mailing address:
  • Phone: 317-434-4114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCC04636
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number39004556A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: