Provider Demographics
NPI:1811609506
Name:SHAVER, ANGELICAH BRIEANNE (MSED, NCC)
Entity type:Individual
Prefix:
First Name:ANGELICAH
Middle Name:BRIEANNE
Last Name:SHAVER
Suffix:
Gender:F
Credentials:MSED, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 N HOBART RD
Mailing Address - Street 2:
Mailing Address - City:HOBART
Mailing Address - State:IN
Mailing Address - Zip Code:46342-2440
Mailing Address - Country:US
Mailing Address - Phone:219-628-0929
Mailing Address - Fax:
Practice Address - Street 1:2801 BERTHOLET BLVD STE 301
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-7959
Practice Address - Country:US
Practice Address - Phone:219-323-3311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-14
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health