Provider Demographics
NPI:1871635417
Name:SHAYE, SEYMOUR (MA)
Entity Type:Individual
Prefix:MR
First Name:SEYMOUR
Middle Name:
Last Name:SHAYE
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1506 KAY LN NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30306-2108
Mailing Address - Country:US
Mailing Address - Phone:678-595-6116
Mailing Address - Fax:404-891-3749
Practice Address - Street 1:1506 KAY LN NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30306-2108
Practice Address - Country:US
Practice Address - Phone:678-595-6116
Practice Address - Fax:404-891-3749
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA12041041C0700X, 101YM0800X
GA567106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1204OtherLPC
GA567OtherMFT
11847617OtherGA LPC #1204; GA LMFT #567