1578609368 NPI number — MRS. SHAWNTA DYNISE BRENT LSW, LPCC

Table of content: MRS. SHAWNTA DYNISE BRENT LSW, LPCC (NPI 1578609368)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578609368 NPI number — MRS. SHAWNTA DYNISE BRENT LSW, LPCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRENT
Provider First Name:
SHAWNTA
Provider Middle Name:
DYNISE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LSW, LPCC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
THOMAS
Provider Other First Name:
SHAWNTA
Provider Other Middle Name:
DYNISE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LSW, PC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1578609368
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/23/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1490 UNIVERSITY BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAMILTON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45011-3305
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-896-7887
Provider Business Mailing Address Fax Number:
513-896-5682

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1821 SUMMIT RD
Provider Second Line Business Practice Location Address:
SUITE 216
Provider Business Practice Location Address City Name:
CINCINNATI
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45237-2822
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-948-0023
Provider Business Practice Location Address Fax Number:
513-948-0087
Provider Enumeration Date:
01/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  S23628 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: E0008428 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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