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General NPI Number Information
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NPI Number | 1174635619
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Entity Type | Individual
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Provider Name | SUSAN KATHLEEN SHEARER CPAT
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Gender | Female
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 6200 CRESTWOOD STA STE A
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City | CRESTWOOD
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State | KY
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Zip | 40014-7418
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Country | US
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Telephone | 502-241-2909
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Fax | 502-241-6811
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Provider Business Mailing Address
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Address Line | PO BOX 73070
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City | CLEVELAND
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State | OH
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Zip | 44193-0002
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Country | US
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Telephone | 502-241-2909
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Fax | 502-241-6811
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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 | 0125
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License Number State | KY
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