Healthcare Provider Details

I. General information

NPI: 1497674790
Provider Name (Legal Business Name): SHOPTALK THERAPEUTIC SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9834 PLEASANT LAKE BLVD APT U2
PARMA OH
44130-7495
US

IV. Provider business mailing address

9834 PLEASANT LAKE BLVD APT U2
PARMA OH
44130-7495
US

V. Phone/Fax

Practice location:
  • Phone: 347-292-1978
  • Fax:
Mailing address:
  • Phone: 347-292-1978
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name: TY'ASIA L JONES
Title or Position: OWNER/CEO
Credential:
Phone: 347-292-1978