Healthcare Provider Details

I. General information

NPI: 1457066342
Provider Name (Legal Business Name): SHANYCE MATTHEWS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2023
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

431 OHIO PIKE STE 312
CINCINNATI OH
45255-3629
US

IV. Provider business mailing address

10150 ARBORWOOD DR APT 521
CINCINNATI OH
45251-1525
US

V. Phone/Fax

Practice location:
  • Phone: 513-770-1705
  • Fax:
Mailing address:
  • Phone: 502-602-1965
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE.2505456
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: