Amy Lee Shute, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

C2868 Issued in MS

Practice address

2240 Westbrook Rd
Jackson, MS 39211-4900

Phone

(601) 957-7373

Fax

(601) 957-7372

NPI assigned

Mar 29, 2011

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Mrs. Amy Lee Burleson Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Interoperability endpoints

• Direct secure messaging: imaginebehavioralhealth.amyarnot@139031.advancedmd-direct.com

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

{
    "created_epoch": "1301356800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1301356800000",
    "number": "1154610285",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 STILLHOUSE CREEK DR",
            "city": "MADISON",
            "state": "MS",
            "postal_code": "391106943",
            "telephone_number": "601-291-1010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2240 WESTBROOK RD",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392114900",
            "telephone_number": "601-957-7373",
            "fax_number": "601-957-7372"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHUTE",
        "first_name": "AMY",
        "middle_name": "LEE",
        "name_prefix": "Mrs.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-03-29",
        "last_updated": "2011-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MS",
            "license": "C2868",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "62209",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AMY",
            "last_name": "BURLESON",
            "middle_name": "LEE",
            "prefix": "MRS.",
            "credential": "LCSW",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Josh R Shufelt, PA-C
• Mrinal Shukla, M.D.
• Gretchen S. Shull, ANP
• Grace G Shumaker, M.D.
• Michael Garret Shumaker, PSY.D.
• Xiaohong Si
• Ishaa Saleem Siddiqui
• Carey McLellan Silas, PHARMD
• Bernice Spiegel Silberman, LCSW
• Silver Platter Enterprises Inc.

• Clinical Social Worker in Jackson, MS
• Providers in Jackson, MS by specialty
• Clinical Social Worker in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 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.

Verify at the official NPI Registry.