Provider Demographics
NPI:1265068712
Name:SHIELDS, DESIREE NICOLE
Entity type:Individual
Prefix:
First Name:DESIREE
Middle Name:NICOLE
Last Name:SHIELDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DESIREE
Other - Middle Name:NICOLE
Other - Last Name:GONZALES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:MAIL BOX 0034
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45221-0034
Mailing Address - Country:US
Mailing Address - Phone:513-556-0648
Mailing Address - Fax:513-556-2302
Practice Address - Street 1:225 CALHOUN ST
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45221-1447
Practice Address - Country:US
Practice Address - Phone:513-556-0648
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-17
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHM.2000184-TRNE106H00000X
OHF.2300338106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist