MEDICARE: SHELLE MATHIS L.P.C.C.

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	101YP2500X	Professional Counselor	C 0600302	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	:	1801119789
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELLE MATHIS L.P.C.C.

Provider Business Mailing Address
First Line	:	611 GARFIELD AVE
Second Line	:
City	:	ELYRIA
State	:	OH
Zip	:	44035-3403
Country	:	US
Telephone Number	:	440-322-7551
Fax Number	:	440-322-7551

Provider Business Practice Location Address
First Line	:	611 GARFIELD AVE
Second Line	:
City	:	ELYRIA
State	:	OH
Zip	:	44035-3403
Country	:	US
Telephone Number	:	440-322-7551
Fax Number	:	440-322-7551

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

Provider Enumeration Date	:	03/08/2010
Last Update Date	:	05/28/2020

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