Healthcare Provider Details

I. General information

NPI: 1922529635
Provider Name (Legal Business Name): SHELBY LINK MS, LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2017
Last Update Date: 02/11/2024
Certification Date: 02/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 HADLEY AVE
OAKWOOD OH
45419-2610
US

IV. Provider business mailing address

308 HADLEY AVE
OAKWOOD OH
45419-2610
US

V. Phone/Fax

Practice location:
  • Phone: 937-369-0863
  • Fax:
Mailing address:
  • Phone: 937-369-0863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberE.1901465
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC.1700482
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: