Melissa Bordelon Shields, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

1912 Issued in MS

Practice address

613 Marquette Rd
Brandon, MS 39042-3038

Phone

(601) 825-8800

Fax

(601) 824-0349

NPI assigned

Aug 21, 2014

Last updated

Aug 21, 2014By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1408579200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1408579200000",
    "number": "1134528516",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 88",
            "city": "BRANDON",
            "state": "MS",
            "postal_code": "390430088",
            "telephone_number": "601-825-8800",
            "fax_number": "601-824-0349"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "613 MARQUETTE RD",
            "city": "BRANDON",
            "state": "MS",
            "postal_code": "390423038",
            "telephone_number": "601-825-8800",
            "fax_number": "601-824-0349"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BORDELON SHIELDS",
        "first_name": "MELISSA",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-08-21",
        "last_updated": "2014-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MS",
            "license": "1912",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Professional Counselor in Brandon, MS
• Providers in Brandon, MS by specialty
• Professional Counselor in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2014; 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.