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General NPI Number Information
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NPI Number | 1043761059
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Entity Type | Individual
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Provider Name | JASON SHELLER
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Gender | Male
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Dates
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Enumeration Date | 10/14/2016
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Last Update Date | 05/02/2018
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Provider Practice Location Address
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Address Line | 3920 LOVERS LN
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City | RAVENNA
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State | OH
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Zip | 44266-4200
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Country | US
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Telephone | 330-673-1347
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Fax |
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Provider Business Mailing Address
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Address Line | 3920 LOVERS LN
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City | RAVENNA
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State | OH
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Zip | 44266-4200
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Country | US
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Telephone | 330-673-1347
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Fax |
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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 | C.1700263
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CDCA.150199
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License Number State | OH
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