Provider Demographics
NPI:1629450572
Name:SHEBLE, BRIAN (PHD, NCSP, LPC, NCC)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:
Last Name:SHEBLE
Suffix:
Gender:M
Credentials:PHD, NCSP, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4163 AVERY LN
Mailing Address - Street 2:
Mailing Address - City:BRIDGETON
Mailing Address - State:MO
Mailing Address - Zip Code:63044-3402
Mailing Address - Country:US
Mailing Address - Phone:314-302-3594
Mailing Address - Fax:
Practice Address - Street 1:745 CRAIG RD STE 111
Practice Address - Street 2:
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-7122
Practice Address - Country:US
Practice Address - Phone:314-302-3594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-26
Last Update Date:2019-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017009643101Y00000X, 101YP2500X, 101YM0800X
MO38296 NCSP103TS0200X
MO258425103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool