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General NPI Number Information
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NPI Number | 1023413770
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Entity Type | Individual
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Provider Name | SHAREHAN AYESH MA, LPCC-S
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Gender | Female
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Dates
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Enumeration Date | 10/23/2014
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Last Update Date | 09/24/2024
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Provider Practice Location Address
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Address Line | 3332 MARPAT LN
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City | BRUNSWICK
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State | OH
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Zip | 44212-5901
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Country | US
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Telephone | 901-254-3156
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Fax | 330-460-5524
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Provider Business Mailing Address
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Address Line | 3332 MARPAT LN
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City | BRUNSWICK
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State | OH
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Zip | 44212-5901
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Country | US
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Telephone | 901-254-3156
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Fax | 330-460-5524
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 3820
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | E.2404318
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 6401014534
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License Number State | MI
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