Healthcare Provider Details

I. General information

NPI: 1427537133
Provider Name (Legal Business Name): SHAUN DALE MEWES LMHP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2018
Last Update Date: 08/09/2023
Certification Date: 08/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 ENTERPRISE ST STE 104
ELIZABETH PA
15037-2070
US

IV. Provider business mailing address

402 POLO CLUB DR
MOON TOWNSHIP PA
15108-4711
US

V. Phone/Fax

Practice location:
  • Phone: 412-754-1100
  • Fax:
Mailing address:
  • Phone: 402-239-0155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC.0017449
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2664
License Number StateNE
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC015802
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: