Healthcare Provider Details

I. General information

NPI: 1104709112
Provider Name (Legal Business Name): MARY SHANNON NEWTON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2025
Last Update Date: 08/18/2025
Certification Date: 08/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10427 DETROIT AVE
CLEVELAND OH
44102-1645
US

IV. Provider business mailing address

10427 DETROIT AVE
CLEVELAND OH
44102-1645
US

V. Phone/Fax

Practice location:
  • Phone: 216-521-6511
  • Fax: 216-521-6006
Mailing address:
  • Phone: 216-521-6511
  • Fax: 216-521-6006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC.2507177
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC.2507177
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: