Active NPI
Mechelle Lynette Shea
- Child Mental Illness Respite Care
- Douglas, AZ
National Provider Identifier
1124327747
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Child Mental Illness Respite Care
- License
- 2397966
- Practice address
- 2805 E 9TH St
Douglas, AZ 85607-2715 - Phone
- (830) 391-5454
- NPI assigned
- Mar 22, 2011
- Last updated
- Mar 22, 2011
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Child Mental Illness Respite Care | 385HR2055X | 2397966 | AZ | Primary |
Addresses
Primary practice location
2805 E 9TH St
Douglas, AZ 85607-2715
Mailing address
2805 E 9TH St
Douglas, AZ 85607-2715
Phone (830) 391-5454
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 |
|---|---|---|---|
| 2397966 | AZ | MD | Child Mental Illness Respite Care |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1300752000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1300752000000",
"number": "1124327747",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2805 E 9TH ST",
"city": "DOUGLAS",
"state": "AZ",
"postal_code": "856072715",
"telephone_number": "830-391-5454"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2805 E 9TH ST",
"city": "DOUGLAS",
"state": "AZ",
"postal_code": "856072715",
"telephone_number": "830-391-5454"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHEA",
"first_name": "MECHELLE",
"middle_name": "LYNETTE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-03-22",
"last_updated": "2011-03-22",
"status": "A"
},
"taxonomies": [
{
"code": "385HR2055X",
"taxonomy_group": "",
"desc": "Respite Care, Respite Care, Mental Illness, Child",
"state": "AZ",
"license": "2397966",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Douglas, AZ
- Saddle Gap Emergency Physicians LLC
- Safeway Inc (Safeway Pharmacy #1139)
- Sarah Ann Samuel, PHARMD
- Harley G Schalesky, MD
- Cheryl E Schmitt, O.D.
- Trevor Ivan Shumaker
- Julie Ann Siddens, SLP
- South Eastern Arizona Behavioral Health Services, Inc. (Douglas Integrated Counseling Clinic)
- Southeastern Arizona Behavioral Health Service, Inc
- Southeastern Arizona Behavioral Health Services, Inc.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.