Healthcare Provider Details

I. General information

NPI: 1639675903
Provider Name (Legal Business Name): SHIRA ALT LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2018
Last Update Date: 02/20/2026
Certification Date: 02/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 E MAIN ST
BEXLEY OH
43209-2536
US

IV. Provider business mailing address

1233 MEDFORD RD
COLUMBUS OH
43209-2840
US

V. Phone/Fax

Practice location:
  • Phone: 336-223-6013
  • Fax:
Mailing address:
  • Phone: 336-223-6013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC.1400117
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: