Active NPI
Jason S Shaw
- Professional Counselor
- Abilene, TX
National Provider Identifier
1043721376
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 74762
- Practice address
- 147 Sayles Blvd
Abilene, TX 79605-2001 - Phone
- (325) 437-1852
- Fax
- (325) 437-4082
- NPI assigned
- Oct 13, 2017
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 74762 | TX | Primary |
| Counselor | 101Y00000X | 74762 | TX |
Addresses
Primary practice location
147 Sayles Blvd
Abilene, TX 79605-2001
Mailing address
294 Medical Dr
Abilene, TX 79601-4554
Phone (325) 437-6859
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 74762 | Other | TX | LPC LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sondermind Provider Network LLC | Professional | Current | Accepting new patients |
| New Horizons Ranch and Center, Inc. | Past | Accepting new patients |
Locations
2021 Guadalupe St
Ste 260
Austin, TX 78705
Phone (202) 932-9958
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.
-
- Emotionally Disturbed Childrens' Residential Treatment Facility
- Abilene, TX
- NPI 1124154224
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1507852800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1720569600000",
"number": "1043721376",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "294 MEDICAL DR",
"city": "ABILENE",
"state": "TX",
"postal_code": "796014554",
"telephone_number": "325-437-6859",
"fax_number": "325-437-4082"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "147 SAYLES BLVD",
"city": "ABILENE",
"state": "TX",
"postal_code": "796052001",
"telephone_number": "325-437-1852",
"fax_number": "325-437-4082"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHAW",
"first_name": "JASON",
"middle_name": "S",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-10-13",
"last_updated": "2024-07-10",
"certification_date": "2024-07-10",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "TX",
"license": "74762",
"primary": true
},
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "TX",
"license": "74762",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LPC LICENSE",
"identifier": "74762",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Abilene, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2024; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.