MEDICARE: DYLAN JAMES SHEARER NCC, LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	PC015404	PA
2	101YP2500X	Professional Counselor		PA

General Provider Information

NPI Number	:	1023744372
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DYLAN JAMES SHEARER NCC, LPC

Provider Business Mailing Address
First Line	:	11676 PERRY HWY STE 2100
Second Line	:
City	:	WEXFORD
State	:	PA
Zip	:	15090-7203
Country	:	US
Telephone Number	:	610-892-3800
Fax Number	:	724-934-5955

Provider Business Practice Location Address
First Line	:	11676 PERRY HWY STE 2100
Second Line	:
City	:	WEXFORD
State	:	PA
Zip	:	15090-7203
Country	:	US
Telephone Number	:	610-892-3800
Fax Number	:	724-934-5955

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2022
Last Update Date	:	11/03/2024

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