Laura Shacklette, LPCC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

275547 Issued in KY

Practice address

728 Chestnut St Ste 202
Bowling Green, KY 42101-6922

Phone

(270) 202-8669

NPI assigned

Oct 18, 2017

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Cardinal Behavioral Health PLLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Bowling Green, KY
  • NPI 1366112823

  Professional

  NPD (past)
• Lifeskills, Inc.

  • Community/Behavioral Health Agency
  • Bowling Green, KY
  • NPI 1669401816
  NPD (past)

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

{
    "created_epoch": "1508284800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1652918400000",
    "number": "1184135154",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "728 CHESTNUT ST STE 202",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421016922",
            "telephone_number": "270-202-8669"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "728 CHESTNUT ST STE 202",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421016922",
            "telephone_number": "270-202-8669"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHACKLETTE",
        "first_name": "LAURA",
        "credential": "LPCC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-10-18",
        "last_updated": "2022-05-19",
        "certification_date": "2022-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "KY",
            "license": "275547",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30604011",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kristen Sexton
• Rachel Sexton, BHS
• Sfreeman Inc.
• Hannah Nicole Shackelford, BS, RBT
• Jo Shackelford, ED.D., CCC-SLP
• Emily Elizabeth Shaddox
• David Shadowen, M.D.
• Vivek Prakash Shah
• Morteza Shahmir, M.D.
• Areeba Shahnawaz, MD

• Professional Counselor in Bowling Green, KY
• Providers in Bowling Green, KY by specialty
• Professional Counselor in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2022; 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.