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NPI Code Detail

MEDICARE: MR. STEPHEN WILLIAM SHIELDS I M.A. LMHC LCAC

MEDICARE: MR. STEPHEN WILLIAM SHIELDS I M.A. LMHC LCAC
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
1101YA0400XAddiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number : 1831119007
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. STEPHEN WILLIAM SHIELDS I M.A. LMHC LCAC
Provider Business Mailing Address
First Line : 5940 CROOKED CREEK DR
Second Line : CPC LLC
City : INDIANAPOLIS
State : IN
Zip : 46228-1236
Country : US
Telephone Number : 317-457-2848
Fax Number : 317-640-2822
Provider Business Practice Location Address
First Line : 5940 CROOKED CREEK DR
Second Line : CPC LLC
City : INDIANAPOLIS
State : IN
Zip : 46228-1236
Country : US
Telephone Number : 317-457-2848
Fax Number : 317-640-2822
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/20/2006
Last Update Date : 12/26/2013

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