Healthcare Provider Details

I. General information

NPI: 1326021775
Provider Name (Legal Business Name): RUTH L SHASTEEN LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 N HARRISON ST
WARSAW IN
46580-3163
US

IV. Provider business mailing address

2860 NORTHPARK AVE
HUNTINGTON IN
46750-9700
US

V. Phone/Fax

Practice location:
  • Phone: 574-267-7169
  • Fax: 574-269-3995
Mailing address:
  • Phone: 260-356-2875
  • Fax: 260-358-0611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number39001590A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: