=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518387091
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LINDA CAROL SHUTOK-LEROY LPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/23/2014
-----------------------------------------------------
Last Update Date | 03/16/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 540 DELWAR RD
-----------------------------------------------------
City | PITTSBURGH
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15236-1309
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-737-3663
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 660 LAKESIDE DR
-----------------------------------------------------
City | CANONSBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15317-2485
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-514-7256
-----------------------------------------------------
Fax | 724-514-7256
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 20-3322716
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------