Johnny Shaw

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

CDCA.175616 Issued in MS

Practice address

1547 W Broad St
Columbus, OH 43222-1043

Phone

(614) 352-2620

Fax

(614) 675-2577

NPI assigned

Mar 9, 2021

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

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1615248000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615248000000",
    "number": "1194310318",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1547 W BROAD ST",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432221043",
            "telephone_number": "614-352-2620"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1547 W BROAD ST",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432221043",
            "telephone_number": "614-352-2620",
            "fax_number": "614-675-2577"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAW",
        "first_name": "JOHNNY",
        "name_prefix": "Mr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-03-09",
        "last_updated": "2021-03-09",
        "certification_date": "2021-03-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MS",
            "license": "CDCA.175616",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "occs.rcs@outlook.com",
            "affiliation": "Y",
            "affiliationName": "Outreach and Crisis Counseling Services",
            "address_1": "1547 W Broad St",
            "city": "Columbus",
            "state": "OH",
            "country_code": "US",
            "postal_code": "432221043",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Desirae S Shaw
• Hezekiah Shaw
• Janette Shaw
• Jannis Shaw, MFTT
• Joel Lewis Shaw, M.D.
• Karen Shaw
• Kenyatta Shaw
• Kevin Mark Shaw
• Lashawnda D Shaw
• Mary Ann Shaw

• Addiction (Substance Use Disorder) Counselor in Columbus, OH
• Providers in Columbus, OH by specialty
• Addiction (Substance Use Disorder) Counselor in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2021; 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.