NPIMap

Organization Active NPI

Shady Grove Behavioral Health, LLC

  • Mental Health Counselor
  • Greenwood, IN
National Provider Identifier
1265965859
Registry record updated Apr 10, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
39003025A Issued in IN
Legal business name
SHADY GROVE BEHAVIORAL HEALTH, LLC
Practice address
3786 Harrison Crossing LN
Greenwood, IN 46142-7616
Phone
(317) 709-3402
NPI assigned
Apr 10, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 10, 2017

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

Authorized official

Name
Candice Due, LMHCNPI 1982156105
Title
Licensed Mental Health Counselor
Phone
(317) 709-3402

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193400000X SINGLE SPECIALTY GROUP 101YM0800X 39003025A IN Primary

Addresses

Primary practice location

3786 Harrison Crossing LN
Greenwood, IN 46142-7616

Mailing address

3786 Harrison Crossing LN
Greenwood, IN 46142-7616

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1491782400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1491782400000",
    "number": "1265965859",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3786 HARRISON CROSSING LN",
            "city": "GREENWOOD",
            "state": "IN",
            "postal_code": "461427616"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3786 HARRISON CROSSING LN",
            "city": "GREENWOOD",
            "state": "IN",
            "postal_code": "461427616",
            "telephone_number": "317-709-3402"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHADY GROVE BEHAVIORAL HEALTH, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-04-10",
        "last_updated": "2017-04-10",
        "status": "A",
        "authorized_official_last_name": "DUE",
        "authorized_official_first_name": "CANDICE",
        "authorized_official_title_or_position": "LICENSED MENTAL HEALTH COUNSELOR",
        "authorized_official_telephone_number": "317-709-3402",
        "authorized_official_credential": "LMHC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": "IN",
            "license": "39003025A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenwood, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2017; 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.