Healthcare Provider Details

I. General information

NPI: 1225524481
Provider Name (Legal Business Name): SHARI MATHEWS LMHCA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2018
Last Update Date: 07/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1806 W ROYALE DR
MUNCIE IN
47304-2243
US

IV. Provider business mailing address

15214 TROXEL DR E APT 304
NOBLESVILLE IN
46060-5809
US

V. Phone/Fax

Practice location:
  • Phone: 765-381-4578
  • Fax:
Mailing address:
  • Phone: 765-425-9317
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number88000323A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: