Healthcare Provider Details

I. General information

NPI: 1174293500
Provider Name (Legal Business Name): SHELBY MARILYN DRIVER LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2021
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22255 CENTER RIDGE RD STE 300
ROCKY RIVER OH
44116-3964
US

IV. Provider business mailing address

250 RIVER ST APT A8
KENT OH
44240-3560
US

V. Phone/Fax

Practice location:
  • Phone: 216-563-1661
  • Fax: 330-544-9379
Mailing address:
  • Phone: 330-614-5306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.2606841
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: