=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689144834
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PHOENIX COUNSELING & MEDATION SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/30/2018
-----------------------------------------------------
Last Update Date | 07/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 670A E MAIN ST
-----------------------------------------------------
City | BARNESVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43713-1455
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-619-0363
-----------------------------------------------------
Fax | 740-619-0347
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 670A E MAIN ST
-----------------------------------------------------
City | BARNESVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43713-1455
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-619-0363
-----------------------------------------------------
Fax | 740-619-0347
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MS. PENELOPE SHEPHERD
-----------------------------------------------------
Credential | LPCC-S
-----------------------------------------------------
Telephone | 740-213-0381
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------