Active NPI
Shanda Retrell Riley, L.C.S.W.
- Mental Health Counselor
- Mesquite, TX
National Provider Identifier
1124330188
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 29588
- Practice address
- 813 Interstate 30
Apt. 731
Mesquite, TX 75150-7494 - Phone
- (214) 417-6831
- NPI assigned
- Jul 7, 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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 29588 | TX | Primary |
Addresses
Primary practice location
813 Interstate 30
Apt. 731
Mesquite, TX 75150-7494
Mailing address
813 Interstate 30
Apt. 731
Mesquite, TX 75150-7494
Phone (214) 417-6831
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 29588 | TX | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Assurasource LTD | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Clinical Social Worker
- Plano, TX
- NPI 1194746016
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1278460800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1362528000000",
"number": "1124330188",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "813 INTERSTATE 30",
"address_2": "APT. 731",
"city": "MESQUITE",
"state": "TX",
"postal_code": "751507494",
"telephone_number": "214-417-6831"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "813 INTERSTATE 30",
"address_2": "APT. 731",
"city": "MESQUITE",
"state": "TX",
"postal_code": "751507494",
"telephone_number": "214-417-6831"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RILEY",
"first_name": "SHANDA",
"middle_name": "RETRELL",
"credential": "L.C.S.W.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-07-07",
"last_updated": "2013-03-06",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "TX",
"license": "29588",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mesquite, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.