Active NPI
Shantra Beane, LPC, LCAS
- Counselor
- Winston Salem, NC
National Provider Identifier
1063634442
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- 4302
- Practice address
- 3821 Forrestgate Dr
Dba Forsyth Behavior Health
Winston Salem, NC 27103-2930 - Phone
- (336) 277-1811
- NPI assigned
- May 3, 2007
- Last updated
- Sep 30, 2010
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | 4302 | NC | Primary |
Addresses
Primary practice location
3821 Forrestgate Dr
Dba Forsyth Behavior Health
Winston Salem, NC 27103-2930
Mailing address
5807 Harvest Springs Drive
Greensboro, NC 27406-8045
Phone (336) 963-4517
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 |
|---|---|---|---|
| 4302 | NC | MD | Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178150400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1285804800000",
"number": "1063634442",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5807 HARVEST SPRINGS DRIVE",
"city": "GREENSBORO",
"state": "NC",
"postal_code": "274068045",
"telephone_number": "336-963-4517"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3821 FORRESTGATE DR",
"address_2": "DBA FORSYTH BEHAVIOR HEALTH",
"city": "WINSTON SALEM",
"state": "NC",
"postal_code": "271032930",
"telephone_number": "336-277-1811"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BEANE",
"first_name": "SHANTRA",
"credential": "LPC, LCAS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-05-03",
"last_updated": "2010-09-30",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "NC",
"license": "4302",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Winston Salem, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.