Active NPI
Ruth Marie Shalley, LCSW
- Mental Health Counselor
- Greencastle, IN
National Provider Identifier
1265471197
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 34004443A
- Practice address
- 308 Medic Way
Greencastle, IN 46135-2296 - Phone
- (765) 653-2669
- Fax
- (765) 653-8671
- NPI assigned
- Jun 6, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 34004443A | IN | Primary |
Addresses
Primary practice location
308 Medic Way
Greencastle, IN 46135-2296
Mailing address
156 Andrews Blvd
Plainfield, IN 46168-9769
Phone (317) 371-2302
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000000207865 | Other | IN | ANTHEM BCBS PROVIDER PIN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 34004443A | IN | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149552000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1185148800000",
"number": "1265471197",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "156 ANDREWS BLVD",
"city": "PLAINFIELD",
"state": "IN",
"postal_code": "461689769",
"telephone_number": "317-371-2302",
"fax_number": "765-653-8671"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "308 MEDIC WAY",
"city": "GREENCASTLE",
"state": "IN",
"postal_code": "461352296",
"telephone_number": "765-653-2669",
"fax_number": "765-653-8671"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHALLEY",
"first_name": "RUTH",
"middle_name": "MARIE",
"name_prefix": "Miss",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-06",
"last_updated": "2007-07-23",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "IN",
"license": "34004443A",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM BCBS PROVIDER PIN",
"identifier": "000000207865",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Greencastle, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.