Shelly R Carlson, QMHA

Primary specialty

Rehabilitation PractitionerTaxonomy code 225400000X

Practice address

3723 Fairview Industrial Dr SE Ste 170
Salem, OR 97302-1174

Phone

(503) 371-1970

Fax

(503) 371-0192

NPI assigned

May 27, 2020

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

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Locations

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.

• Coaction, Inc.

  dba Mid-Valley Pain Clinic

  • Clinic/Center
  • Salem, OR
  • NPI 1275795619
  NPD Authorized official

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

{
    "created_epoch": "1590537600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1590537600000",
    "number": "1174146948",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3723 FAIRVIEW INDUSTRIAL DR SE STE 170",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973021174",
            "telephone_number": "503-371-1970",
            "fax_number": "503-371-0192"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3723 FAIRVIEW INDUSTRIAL DR SE STE 170",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973021174",
            "telephone_number": "503-371-1970",
            "fax_number": "503-371-0192"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARLSON",
        "first_name": "SHELLY",
        "middle_name": "R",
        "credential": "QMHA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-05-27",
        "last_updated": "2020-05-27",
        "certification_date": "2020-05-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225400000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Practitioner",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "mvpclinic.com",
            "affiliation": "N",
            "endpointDescription": "email and website",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "DATA and CORRESPONDENCE",
            "address_1": "3723 Fairview Industrial Dr SE Ste 170",
            "city": "Salem",
            "state": "OR",
            "country_code": "US",
            "postal_code": "973021174",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Viola Carlile, ATR, LPC
• Dean H Carlisle, M.A., QMHP
• Amber Carlson
• Deborah Lee Carlson, M.D.
• Lauren Carlson, MSN, APRN, FNP-C
• Siri Carlson
• Susan Kathryn Carlson, MA COUNSELING
• Sarah Marie Carlton
• Shannon Marie Carlton, HHC
• Mindy M Carmack

• Rehabilitation Practitioner in Salem, OR
• Providers in Salem, OR by specialty
• Rehabilitation Practitioner in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2020; 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.