=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659018059
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHOALEH DJEBELLI LMHC, LPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/17/2022
-----------------------------------------------------
Last Update Date | 05/17/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16950 N BAY RD APT 1610
-----------------------------------------------------
City | SUNNY ISLES BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33160-4246
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-735-3083
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16950 N BAY RD APT 1610
-----------------------------------------------------
City | SUNNY ISLES BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33160-4246
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-735-3083
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------