Healthcare Provider Details

I. General information

NPI: 1336737022
Provider Name (Legal Business Name): SHANELL LYNN THOMAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2021
Last Update Date: 01/07/2021
Certification Date: 01/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 COMPTON RD
CINCINNATI OH
45231-3826
US

IV. Provider business mailing address

800 COMPTON RD
CINCINNATI OH
45231-3826
US

V. Phone/Fax

Practice location:
  • Phone: 513-960-8633
  • Fax: 513-960-8633
Mailing address:
  • Phone: 513-860-9633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: