Provider Demographics
NPI:1427537133
Name:MEWES, SHAUN DALE (LMHP)
Entity Type:Individual
Prefix:MR
First Name:SHAUN
Middle Name:DALE
Last Name:MEWES
Suffix:
Gender:M
Credentials:LMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 POLO CLUB DR
Mailing Address - Street 2:
Mailing Address - City:MOON TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:15108-4711
Mailing Address - Country:US
Mailing Address - Phone:402-239-0155
Mailing Address - Fax:
Practice Address - Street 1:95 ENTERPRISE ST STE 104
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:PA
Practice Address - Zip Code:15037-2070
Practice Address - Country:US
Practice Address - Phone:412-754-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-13
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0017449101YP2500X
NE2664101YP2500X, 101YP2500X
PAPC015802101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional