Individual
KENNETH L. SHIELDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMHC
Contact information
Practice address
11104 PARKVIEW CIRCLE DR, STE 110, FORT WAYNE, IN 46845-1730
(260) 460-3203
(260) 460-3130
Mailing address
11104 PARKVIEW CIRCLE DR, STE 110, FORT WAYNE, IN 46845-1730
(260) 460-3203
(260) 460-3130
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
87001425A
IN
101YM0800X
Mental Health Counselor
Primary
39001242A
IN
Other
Enumeration date
07/01/2005
Last updated
12/26/2012
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