Provider Demographics
NPI:1083689210
Name:SHOEMAKER, STACEY J (LPCC)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:J
Last Name:SHOEMAKER
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4440 GLEN ESTE WITHAMSVILLE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45245-1318
Mailing Address - Country:US
Mailing Address - Phone:513-354-5735
Mailing Address - Fax:513-753-7930
Practice Address - Street 1:4440 GLEN ESTE WITHAMSVILLE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45245-1318
Practice Address - Country:US
Practice Address - Phone:513-354-5735
Practice Address - Fax:513-753-7930
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE-0003347101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH01183Medicaid