Active NPI
Stacey Christina Shine
- Mental Health Counselor
- Franklin, TN
National Provider Identifier
1275833543
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 5019
- Practice address
- 125 Cool Springs Blvd Ste 270
Franklin, TN 37067-6574 - Phone
- (901) 258-3895
- NPI assigned
- Nov 2, 2010
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Case Manager/Care Coordinator | 171M00000X | |||
| Mental Health Counselor | 101YM0800X | 5019 | TN | Primary |
Addresses
Primary practice location
125 Cool Springs Blvd Ste 270
Franklin, TN 37067-6574
Mailing address
125 Cool Springs Blvd Ste 270
Franklin, TN 37067-6574
Phone (901) 258-3895
Other practice location 1
109 W Watauga Ave
Johnson City, TN 37604-5621
Phone (423) 232-2600
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TN
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Grow Healthcare Group PA | Mental Health | Current | Accepting new patients |
Locations
66 W Flagler St
Ste 900
Miami, FL 33130
Phone (786) 244-7711
40 Burton Hills Blvd
Ste 200
Nashville, TN 37215
Phone (615) 257-8410
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1288656000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1603411200000",
"number": "1275833543",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "125 COOL SPRINGS BLVD STE 270",
"city": "FRANKLIN",
"state": "TN",
"postal_code": "370676574",
"telephone_number": "901-258-3895",
"fax_number": "423-467-3644"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "125 COOL SPRINGS BLVD STE 270",
"city": "FRANKLIN",
"state": "TN",
"postal_code": "370676574",
"telephone_number": "901-258-3895"
}
],
"practiceLocations": [
{
"address_1": "109 W Watauga Ave",
"address_purpose": "LOCATION",
"city": "Johnson City",
"state": "TN",
"postal_code": "376045621",
"country_code": "US",
"telephone_number": "423-232-2600",
"fax_number": "423-467-3644",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "SHINE",
"first_name": "STACEY",
"middle_name": "CHRISTINA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-11-02",
"last_updated": "2020-10-23",
"certification_date": "2020-10-23",
"status": "A"
},
"taxonomies": [
{
"code": "171M00000X",
"taxonomy_group": "",
"desc": "Case Manager/Care Coordinator",
"state": null,
"license": null,
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "TN",
"license": "5019",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Franklin, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.