Active NPI
Miranda S. Shelton
- Addiction (Substance Use Disorder) Counselor
- Mansfield, OH
National Provider Identifier
1023680774
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- CDCA.180023
- Practice address
- 580 Park Ave W
Mansfield, OH 44906-3722 - Phone
- (833) 510-4357
- Fax
- (866) 460-2997
- NPI assigned
- Jul 13, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | CDCA.175537 | OH | |
| Case Manager/Care Coordinator | 171M00000X | OH | ||
| Community Health Worker | 172V00000X | OH | ||
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | CDCA.180023 | OH | Primary |
Addresses
Primary practice location
580 Park Ave W
Mansfield, OH 44906-3722
Mailing address
615 Elsinore PL Ste 200
Cincinnati, OH 45202-1457
Phone (833) 510-4357
Other practice location 1
615 Elsinore Pl Ste 200
Cincinnati, OH 45202-1457
Phone (833) 510-4357
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CDCA.175537 | OH | MD | Addiction (Substance Use Disorder) Counselor |
| CDCA.180023 | OH | MD | Addiction (Substance Use Disorder) Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Brightview, LLC | Past | Accepting new patients | |
| Brightview LLC | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Addiction Medicine (Internal Medicine) Physician
- Cincinnati, OH
- NPI 1659769446
-
- Addiction Medicine (Internal Medicine) Physician
- Asheboro, NC
- NPI 1962163782
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1626134400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1660867200000",
"number": "1023680774",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "615 ELSINORE PL STE 200",
"city": "CINCINNATI",
"state": "OH",
"postal_code": "452021457",
"telephone_number": "833-510-4357",
"fax_number": "866-460-2997"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "580 PARK AVE W",
"city": "MANSFIELD",
"state": "OH",
"postal_code": "449063722",
"telephone_number": "833-510-4357",
"fax_number": "866-460-2997"
}
],
"practiceLocations": [
{
"address_1": "615 Elsinore Pl Ste 200",
"address_purpose": "LOCATION",
"city": "Cincinnati",
"state": "OH",
"postal_code": "452021457",
"country_code": "US",
"telephone_number": "833-510-4357",
"fax_number": "866-460-2997",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "SHELTON",
"first_name": "MIRANDA",
"middle_name": "S.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-07-13",
"last_updated": "2022-08-19",
"certification_date": "2022-08-19",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "OH",
"license": "CDCA.175537",
"primary": false
},
{
"code": "171M00000X",
"taxonomy_group": "",
"desc": "Case Manager/Care Coordinator",
"state": "OH",
"license": null,
"primary": false
},
{
"code": "172V00000X",
"taxonomy_group": "",
"desc": "Community Health Worker",
"state": "OH",
"license": null,
"primary": false
},
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "OH",
"license": "CDCA.180023",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Mansfield, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.