Healthcare Provider Details

I. General information

NPI: 1952007825
Provider Name (Legal Business Name): MICHAEL DANIELLE TUESDAY SHAIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MICHAEL ALLEN

II. Dates (important events)

Enumeration Date: 02/02/2023
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

717 3RD AVE
CHESAPEAKE OH
45619-1040
US

IV. Provider business mailing address

305 N 5TH ST
IRONTON OH
45638-1578
US

V. Phone/Fax

Practice location:
  • Phone: 740-867-6687
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.2403968-TRNE
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.5213162
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLICDC.162918
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: