Shannon K. Dunlap, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY003497 Issued in GA

Practice address

610 Ridley Ave
Lagrange, GA 30240-2236

Phone

(706) 884-5050

Fax

(706) 884-5056

NPI assigned

May 26, 2009

Last updated

Feb 3, 2016By 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 3

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

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.

• Counseling Services of Lagrange, Inc.

  • Clinical Psychologist
  • Lagrange, GA
  • NPI 1790197804
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1243296000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1454457600000",
    "number": "1194950857",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "610 RIDLEY AVE",
            "city": "LAGRANGE",
            "state": "GA",
            "postal_code": "302402236",
            "telephone_number": "706-884-5050",
            "fax_number": "706-884-5056"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "610 RIDLEY AVE",
            "city": "LAGRANGE",
            "state": "GA",
            "postal_code": "302402236",
            "telephone_number": "706-884-5050",
            "fax_number": "706-884-5056"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUNLAP",
        "first_name": "SHANNON",
        "middle_name": "K.",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-05-26",
        "last_updated": "2016-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "GA",
            "license": "202201",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "GA",
            "license": "LPC004718",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "GA",
            "license": "PSY003497",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Annthony Michael Duffey, LCSW
• Paulette Dukes, MCD, CCC-SLP
• Jane Campbell Dunlap, APRN, CRNP
• Ktonya Latrai Dunlap, LPN
• Marlis Jane Faber Dunlap, FNP-C
• Jane Dunn, PT
• Durable Medical Equipment, Inc (Lagrange Healthcare)
• Rod M Duraski, MD
• Gaurav Dutta, M.D.
• Martha Lynne Earley, LPC

• Clinical Psychologist in Lagrange, GA
• Providers in Lagrange, GA by specialty
• Clinical Psychologist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.