Katie Jo Shadrick, MA, LPCC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

CC01886 Issued in MN

Practice address

1310 S German St
New Ulm, MN 56073-3478

Phone

(507) 354-2174

NPI assigned

Aug 30, 2018

Last updated

Mar 30, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

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

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Secure Base Counseling Center LLCGroup PAC ID 8628409299, 22 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

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.

• Secure Base Counseling Center LLC

  • Psychologist
  • Northfield, MN
  • NPI 1285905885
  Medicare reassignment Care Compare group NPD
• Associated Psychological Services

  • Cognitive & Behavioral Psychologist
  • Mankato, MN
  • NPI 1285665877
  NPD (past)
• Thrive Behavioral Network II, LLC

  dba Nova House

  • Mental Illness Community Based Residential Treatment Facility
  • New Ulm, MN
  • NPI 1407072929
  NPD (past)

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

{
    "created_epoch": "1535587200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1585526400000",
    "number": "1275015786",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1310 S GERMAN ST",
            "city": "NEW ULM",
            "state": "MN",
            "postal_code": "560733478"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1310 S GERMAN ST",
            "city": "NEW ULM",
            "state": "MN",
            "postal_code": "560733478",
            "telephone_number": "507-354-2174"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11010 Prairie Lakes Dr Ste 350",
            "address_purpose": "LOCATION",
            "city": "Eden Prairie",
            "state": "MN",
            "postal_code": "553443801",
            "country_code": "US",
            "telephone_number": "952-746-2522",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "113 E Hickory St",
            "address_purpose": "LOCATION",
            "city": "Mankato",
            "state": "MN",
            "postal_code": "560013630",
            "country_code": "US",
            "telephone_number": "507-388-8114",
            "fax_number": "507-388-8068",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHADRICK",
        "first_name": "KATIE",
        "middle_name": "JO",
        "credential": "MA, LPCC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-08-30",
        "last_updated": "2020-03-30",
        "certification_date": "2020-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MN",
            "license": "CC01886",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jan Marie Schwarzrock, MSW, LICSW, RPT
• Jennifer Marie Seavey
• Secure Tactical Transports LLC
• Lisa Sellner, RN
• Serenity Family Counseling LLC
• Aesha Y Shah, MD
• Mary A Shupe, RN
• Charles Sieberg, PHARMD
• Stephen Siegle, PT
• Briana Rae Sieve

• Mental Health Counselor in New Ulm, MN
• Providers in New Ulm, MN by specialty
• Mental Health Counselor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2020; 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.