Sharisse R Edwards, LPCC, LCDC-III

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

E.0500359-SUPV Issued in OH

Practice address

18501 Chagrin Blvd
Shaker Heights, OH 44122-4850

Phone

(216) 647-4532

NPI assigned

Jun 14, 2019

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in OH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mindfully LLCGroup PAC ID 3476606252, 66 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Mindfully, LLC

  • Counselor
  • Fairfield, OH
  • NPI 1972702520

  Addiction (Substance Use Disorder)

  Medicare reassignment Care Compare group NPD
• Mindfully, LLC

  • Counselor
  • Jacksonville, FL
  • NPI 1376271981

  Addiction (Substance Use Disorder)

  NPD
• Mindfully Psychiatry LLC

  • Psychiatry Physician
  • Montgomery, OH
  • NPI 1881341543
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1560470400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560470400000",
    "number": "1497315220",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18501 CHAGRIN BLVD",
            "city": "SHAKER HEIGHTS",
            "state": "OH",
            "postal_code": "441224850",
            "telephone_number": "216-647-4532"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18501 CHAGRIN BLVD",
            "city": "SHAKER HEIGHTS",
            "state": "OH",
            "postal_code": "441224850",
            "telephone_number": "216-647-4532"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDWARDS",
        "first_name": "SHARISSE",
        "middle_name": "R",
        "credential": "LPCC, LCDC-III",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-06-14",
        "last_updated": "2019-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OH",
            "license": "LCDCIII.101156",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "OH",
            "license": "E.0500359-SUPV",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ecsc III LLC
• Anita M Eddie, L.I.S.W.
• Jennifer Eddy, LSW
• Reginald M Edgerson
• Kenneth Lee Edwards, D.P.M.
• Lovie Eggleston
• Katie Cheyfitz Eichenauer, LISW-S
• Barbara Lee Ekelman, PH.D.
• Faisal Elagili, M.D.
• James Ward Elek, MSSA, LSW

• Professional Counselor in Shaker Heights, OH
• Providers in Shaker Heights, OH by specialty
• Professional Counselor in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.