Active NPI
Shelly Noreen Hennings, CDP, NCAC-I
- Addiction (Substance Use Disorder) Counselor
- Tulalip, WA
National Provider Identifier
1104078450
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- CP00006202
- Practice address
- 2821 Mission Hill Rd
Tulalip, WA 98271-9706 - Phone
- (360) 716-4323
- Fax
- (360) 651-4404
- NPI assigned
- Oct 17, 2008
- 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 |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | CP00006202 | WA | Primary |
Addresses
Primary practice location
2821 Mission Hill Rd
Tulalip, WA 98271-9706
Mailing address
2821 Mission Hill Rd
Tulalip, WA 98271-9706
Phone (360) 716-4323
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| CP00006202 | Other | WA | DEPARTMENT OF HEALTH |
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 |
|---|---|---|---|
| CP00006202 | WA | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1224201600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1224201600000",
"number": "1104078450",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2821 MISSION HILL RD",
"city": "TULALIP",
"state": "WA",
"postal_code": "982719706",
"telephone_number": "360-716-4323",
"fax_number": "360-651-4404"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2821 MISSION HILL RD",
"city": "TULALIP",
"state": "WA",
"postal_code": "982719706",
"telephone_number": "360-716-4323",
"fax_number": "360-651-4404"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HENNINGS",
"first_name": "SHELLY",
"middle_name": "NOREEN",
"credential": "CDP, NCAC-I",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-10-17",
"last_updated": "2008-10-17",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "WA",
"license": "CP00006202",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DEPARTMENT OF HEALTH",
"identifier": "CP00006202",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tulalip, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.