Active NPI
Shandra Nicole Shultz, CADC-R, CRM, PSS
- Counselor
- Portland, OR
National Provider Identifier
1124915426
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- T-25-5231
- Practice address
- 3716 NE MLK Jr Blvd
Portland, OR 97212-1111 - Phone
- (503) 288-8066
- NPI assigned
- Jun 19, 2025
- 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 |
|---|---|---|---|---|
| Counselor | 101Y00000X | T-25-5231 | OR | Primary |
Addresses
Primary practice location
3716 NE MLK Jr Blvd
Portland, OR 97212-1111
Mailing address
5415 SW Westgate Dr
Portland, OR 97221-2409
Phone (503) 645-3581
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 |
|---|---|---|---|
| T-25-5231 | OR | MD | Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1750291200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1750291200000",
"number": "1124915426",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5415 SW WESTGATE DR",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972212409",
"telephone_number": "503-645-3581"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3716 NE MLK JR BLVD",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972121111",
"telephone_number": "503-288-8066"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHULTZ",
"first_name": "SHANDRA",
"middle_name": "NICOLE",
"name_prefix": "Mrs.",
"credential": "CADC-R, CRM, PSS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2025-06-19",
"last_updated": "2025-06-19",
"certification_date": "2025-06-19",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "OR",
"license": "T-25-5231",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.