Provider Demographics
NPI:1023413770
Name:AYESH, SHAREHAN (MA, LPCC-S)
Entity type:Individual
Prefix:
First Name:SHAREHAN
Middle Name:
Last Name:AYESH
Suffix:
Gender:F
Credentials:MA, LPCC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3332 MARPAT LN
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:OH
Mailing Address - Zip Code:44212-5901
Mailing Address - Country:US
Mailing Address - Phone:901-254-3156
Mailing Address - Fax:330-460-5524
Practice Address - Street 1:3332 MARPAT LN
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:OH
Practice Address - Zip Code:44212-5901
Practice Address - Country:US
Practice Address - Phone:901-254-3156
Practice Address - Fax:330-460-5524
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-23
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3820101YM0800X
OHE.2404318101YM0800X
MI6401014534101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health