Shawn White, LPCC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

264171 Issued in KY

Practice address

1143 Fairway Street
Ste 103
Bowling Green, KY 42103-2452

Phone

(407) 347-4536

Fax

(812) 285-8392

NPI assigned

Mar 16, 2018

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in KY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Lake Substance Abuse Solutions LLCGroup PAC ID 8123440401, 20 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Lake Substance Abuse Solutions LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Jeffersonville, IN
  • NPI 1124598669

  KY

  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1521158400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705536000000",
    "number": "1073016903",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1143 FAIRWAY STREET",
            "address_2": "STE 103",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421032452",
            "telephone_number": "407-347-4536",
            "fax_number": "812-285-8392"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1143 FAIRWAY STREET",
            "address_2": "STE 103",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421032452",
            "telephone_number": "407-347-4536",
            "fax_number": "812-285-8392"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WHITE",
        "first_name": "SHAWN",
        "credential": "LPCC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-03-16",
        "last_updated": "2024-01-18",
        "certification_date": "2020-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "KY",
            "license": "264171",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kelly Quinlan White, DPT
• Macy Ann White, OTR/L
• Mary Jessica White, RBT
• Mason Decker White, OTR/L
• Philip Bruce White Jr., DC
• Sarah L Whitledge, LCSW
• Amy Andrews Whitler, APRN
• Lindsey Kate Whitley, LPCC
• Adria Chanell Whitlow, MSW, LCSW-S
• Shelby Whitt, MSW

• Professional Counselor in Bowling Green, KY
• Providers in Bowling Green, KY by specialty
• Professional Counselor in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.