MEDICARE: SHYLA MARIE HOBBS LCDC 3

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	101Y00000X	Counselor
2	175T00000X	Peer Specialist	0002565	OH
3	101Y00000X	Counselor	LCDCIII.162761	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619549656
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHYLA MARIE HOBBS LCDC 3

Provider Business Mailing Address
First Line	:	5649 HICKORY ST
Second Line	:
City	:	MENTOR ON THE LAKE
State	:	OH
Zip	:	44060
Country	:	US
Telephone Number	:	216-849-4963
Fax Number	:

Provider Business Practice Location Address
First Line	:	5649 HICKORY ST
Second Line	:
City	:	MENTOR ON THE LAKE
State	:	OH
Zip	:	44060-4406
Country	:	US
Telephone Number	:	216-849-4963
Fax Number	:

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

Provider Enumeration Date	:	07/10/2021
Last Update Date	:	11/04/2024

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