Robert Allen Shive III

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

3095 Issued in MS

Practice address

141 Township Ave Ste 303
Ridgeland, MS 39157-8699

Phone

(601) 844-3884

NPI assigned

Jul 14, 2022

Last updated

Mar 15, 2024By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Opted out of Medicare

Yes, effective May 6, 2026 through May 6, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Doxa Counseling Services

  • Professional Counselor
  • Ridgeland, MS
  • NPI 1609531458
  NPD

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

{
    "created_epoch": "1657756800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710460800000",
    "number": "1184358137",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4305 AUDUBON PARK LN",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392116141",
            "telephone_number": "601-906-3314"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "141 TOWNSHIP AVE STE 303",
            "city": "RIDGELAND",
            "state": "MS",
            "postal_code": "391578699",
            "telephone_number": "601-844-3884"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHIVE",
        "first_name": "ROBERT",
        "middle_name": "ALLEN",
        "name_suffix": "III",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-07-14",
        "last_updated": "2024-03-15",
        "certification_date": "2024-03-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MS",
            "license": "3095",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.