MEDICARE: DR. BRIAN SHEBLE PH.D, NCSP, LPC, NCC

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	2017009643	MO
2	101YP2500X	Professional Counselor	2017009643	MO
3	103TS0200X	School Psychologist	38296 NCSP	MO
4	103TS0200X	School Psychologist	258425	MO
5	101YM0800X	Mental Health Counselor	2017009643	MO

General Provider Information

NPI Number	:	1629450572
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN SHEBLE PH.D, NCSP, LPC, NCC

Provider Business Mailing Address
First Line	:	4163 AVERY LN
Second Line	:
City	:	BRIDGETON
State	:	MO
Zip	:	63044-3402
Country	:	US
Telephone Number	:	314-302-3594
Fax Number	:

Provider Business Practice Location Address
First Line	:	745 CRAIG RD STE 111
Second Line	:
City	:	CREVE COEUR
State	:	MO
Zip	:	63141-7122
Country	:	US
Telephone Number	:	314-302-3594
Fax Number	:

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

Provider Enumeration Date	:	06/26/2015
Last Update Date	:	05/10/2019

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