Healthcare Provider Details

I. General information

NPI: 1992162861
Provider Name (Legal Business Name): SHANICE LAUB PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2016
Last Update Date: 08/08/2025
Certification Date: 08/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12608 STATE RD STE 1
NORTH ROYALTON OH
44133-3281
US

IV. Provider business mailing address

12608 STATE RD STE 1
NORTH ROYALTON OH
44133-3281
US

V. Phone/Fax

Practice location:
  • Phone: 216-907-1141
  • Fax: 440-345-3456
Mailing address:
  • Phone: 440-907-1141
  • Fax: 440-345-3456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: