Healthcare Provider Details

I. General information

NPI: 1598042533
Provider Name (Legal Business Name): SHEKYRA DECREE PCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2011
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

261 W JOHNSTOWN RD STE 108
GAHANNA OH
43230-2887
US

IV. Provider business mailing address

528 GAYLE DR
GAHANNA OH
43230-2885
US

V. Phone/Fax

Practice location:
  • Phone: 614-454-1377
  • Fax:
Mailing address:
  • Phone: 614-309-2883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number39005705A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH26489
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-MN-365
License Number StateMN
# 4
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.0600534-SUPV
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.0600534
License Number StateOH
# 6
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-AZ-424
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: