MEDICARE: DREAMA SHORT

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	1361	WV

General Provider Information

NPI Number	:	1881933984
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DREAMA SHORT

Provider Business Mailing Address
First Line	:	552 CHERRY CREEK CIR
Second Line	:
City	:	SHADY SPRING
State	:	WV
Zip	:	25918-8723
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1404 RACE ST STE 302
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45202-7366
Country	:	US
Telephone Number	:	513-904-5073
Fax Number	:

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

Provider Enumeration Date	:	02/08/2013
Last Update Date	:	04/07/2026

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Directions to “ DREAMA SHORT ” Practice Location

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