Shelly M Self, LPC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

301 W Main St
Ste 324
Ardmore, OK 73401-6337

Phone

(580) 238-0506

Fax

(580) 238-0506

NPI assigned

Mar 5, 2012

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OK

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

Mental Health Counselor

Education

Other, 2012

Medicare assignment

May accept Medicare assignment

Group practices

Lynch Family Services LLCGroup PAC ID 0446584205, 15 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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 and National Provider Directory roles.

• Lynch Family Services LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Ardmore, OK
  • NPI 1568722379
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1330905600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1444348800000",
    "number": "1265706428",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "704 SHIRLEY LN",
            "city": "MADILL",
            "state": "OK",
            "postal_code": "734469772",
            "telephone_number": "580-238-0506"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 W MAIN ST",
            "address_2": "STE 324",
            "city": "ARDMORE",
            "state": "OK",
            "postal_code": "734016337",
            "telephone_number": "580-238-0506",
            "fax_number": "580-238-0506"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SELF",
        "first_name": "SHELLY",
        "middle_name": "M",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-03-05",
        "last_updated": "2015-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200049040C",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Christopher David Scott, APRN, AGACNP-BC
• Lauren Sears
• Jaqueline Paige Seely
• Kelley Hughes Segler, LPC
• Select Physical Therapy Holdings, Inc. (Select Physical Therapy)
• Sendero Pediatric Therapy LLC
• Vanessa Serrano
• Mahmoud Shadi, M.D.
• Rachel Shaffer
• Bhavin C Shah, MD

• Mental Health Counselor in Ardmore, OK
• Providers in Ardmore, OK by specialty
• Mental Health Counselor in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2015; 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.