NPIMap

Organization Active NPI

Melissa Shane Counseling Services LLC

  • Community/Behavioral Health Agency
  • Peoria, IL
National Provider Identifier
1083125298
Registry record updated Oct 14, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
180008837 Issued in IL
Legal business name
MELISSA SHANE COUNSELING SERVICES LLC
Practice address
6919 N Knoxville Ave Ste 100
Peoria, IL 61614-2858
Phone
(309) 369-3498
Fax
(309) 966-0266
NPI assigned
Oct 14, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 14, 2017

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

Authorized official

Name
Melissa Ann Shane, LCPCNPI 1326476482
Title
Owner
Phone
(309) 369-3498

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X 180008837 IL Primary

Addresses

Primary practice location

6919 N Knoxville Ave Ste 100
Peoria, IL 61614-2858

Mailing address

6919 N Knoxville Ave Ste 100
Peoria, IL 61614-2858
Phone (309) 369-3498

National Provider Directory

National Provider Directory

Locations

8718 N University St
Peoria, IL 61615
Phone (309) 966-0068

6919 N Knoxville Ave
Ste 100
Peoria, IL 61614
Phone (309) 966-0068

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1507939200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1507939200000",
    "number": "1083125298",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6919 N KNOXVILLE AVE STE 100",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616142858",
            "telephone_number": "309-369-3498",
            "fax_number": "309-966-0266"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6919 N KNOXVILLE AVE STE 100",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616142858",
            "telephone_number": "309-369-3498",
            "fax_number": "309-966-0266"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MELISSA SHANE COUNSELING SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-10-14",
        "last_updated": "2017-10-14",
        "status": "A",
        "authorized_official_last_name": "SHANE",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "309-369-3498",
        "authorized_official_credential": "LCPC"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "IL",
            "license": "180008837",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Peoria, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.