Shelby R Banken, MA, LADC

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

305153 Issued in MN

Practice address

13603 80TH Cir N
Maple Grove, MN 55369-8961

Phone

(763) 274-3120

NPI assigned

Nov 15, 2022

Last updated

Nov 15, 2022By 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

Other names 1

• Shelby R Olson Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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.

• Family Support Services Inc.

  dba Sagent Behavioral Health

  • Mental Health Counselor
  • New Brighton, MN
  • NPI 1467549220
  NPD

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

{
    "created_epoch": "1668470400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1668470400000",
    "number": "1295444685",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13603 80TH CIR N",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553698961",
            "telephone_number": "763-274-3120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13603 80TH CIR N",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553698961",
            "telephone_number": "763-274-3120"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BANKEN",
        "first_name": "SHELBY",
        "middle_name": "R",
        "name_prefix": "Mrs.",
        "credential": "MA, LADC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-11-15",
        "last_updated": "2022-11-15",
        "certification_date": "2022-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MN",
            "license": "305153",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHELBY",
            "last_name": "OLSON",
            "middle_name": "R",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Christopher J Bailey, PT
• Bradley Baker
• Bjorn Bakken, MD
• Kristopher Gerald Balgaard, PT
• Ballantine Legacy, LLC
• Rachel Lillian Barger
• Kyle R Barker, MD
• Rachael Barker, O.D.
• Tara Barrack, PA-C
• Monika Barrett

• Addiction (Substance Use Disorder) Counselor in Maple Grove, MN
• Providers in Maple Grove, MN by specialty
• Addiction (Substance Use Disorder) Counselor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2022; 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.