Shelley Stretch, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

2102037164 Issued in MO

Practice address

655 Craig Rd Ste 320
Creve Coeur, MO 63141-7171

Phone

(314) 772-2205

Fax

(314) 772-9264

NPI assigned

Dec 11, 2014

Last updated

Nov 13, 2020By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jan 10, 2024 through Jan 10, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1418256000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1605225600000",
    "number": "1225436959",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8604 GRANTWOOD TRAILS CT",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631231146",
            "telephone_number": "314-882-0619",
            "fax_number": "660-665-3989"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "655 CRAIG RD STE 320",
            "city": "CREVE COEUR",
            "state": "MO",
            "postal_code": "631417171",
            "telephone_number": "314-772-2205",
            "fax_number": "314-772-9264"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STRETCH",
        "first_name": "SHELLEY",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-12-11",
        "last_updated": "2020-11-13",
        "certification_date": "2020-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MO",
            "license": "2012037164",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MO",
            "license": "2102037164",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Professional Counselor in Creve Coeur, MO
• Providers in Creve Coeur, MO by specialty
• Professional Counselor in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2020; 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.