=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942160643
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE SHEA WAY, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/14/2025
-----------------------------------------------------
Last Update Date | 11/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 202 WAREHAM RD APT 9107
-----------------------------------------------------
City | PLYMOUTH
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02360-2584
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-919-9837
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 202 WAREHAM RD APT 9107
-----------------------------------------------------
City | PLYMOUTH
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02360-2584
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-919-9837
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRACTICE OWNER
-----------------------------------------------------
Name | COURTNEY LYNN SHEA
-----------------------------------------------------
Credential | LMHC, LPC
-----------------------------------------------------
Telephone | 401-919-9837
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------