Provider Demographics
NPI:1740691971
Name:SHELL, STEPHANIE
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:SHELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6400 THORNBERRY CT
Mailing Address - Street 2:SUITE 620
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-7818
Mailing Address - Country:US
Mailing Address - Phone:513-229-8386
Mailing Address - Fax:513-229-8385
Practice Address - Street 1:7570 BALES ST STE 380
Practice Address - Street 2:
Practice Address - City:LIBERTY TOWNSHIP
Practice Address - State:OH
Practice Address - Zip Code:45069-7751
Practice Address - Country:US
Practice Address - Phone:513-633-2219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-09
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.1000331101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional