Provider Demographics
NPI:1629385984
Name:SHARTLE, ELIZABETH (PCC-S)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:SHARTLE
Suffix:
Gender:F
Credentials:PCC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 BROAD BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44221-3817
Mailing Address - Country:US
Mailing Address - Phone:330-928-1000
Mailing Address - Fax:
Practice Address - Street 1:141 BROAD BLVD STE 200
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44221-3817
Practice Address - Country:US
Practice Address - Phone:330-928-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-08
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.0800160101YA0400X
OHE0800160101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)