Active NPI
Shirley Christine Zupetz, LADC
- Addiction (Substance Use Disorder) Counselor
- Saint Paul, MN
National Provider Identifier
1306475983
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 305471
- Practice address
- 1137 Grand Ave
Saint Paul, MN 55105 - Phone
- (612) 257-2391
- NPI assigned
- Apr 6, 2020
- Last updated
- Apr 6, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 305471 | MN | Primary |
Addresses
Primary practice location
1137 Grand Ave
Saint Paul, MN 55105
Mailing address
1137 Grand Ave
Saint Paul, MN 55105
Phone (612) 257-2391
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 305471 | Other | MN | LADC LICENSE NUMBER |
Other names 1
- Shirley Christine Mitchell
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | Procentive | Health Information Exchange (HIE) |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 305471 | MN | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1586131200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1586131200000",
"number": "1306475983",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1137 GRAND AVE",
"city": "SAINT PAUL",
"state": "MN",
"postal_code": "55105",
"telephone_number": "612-257-2391"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1137 GRAND AVE",
"city": "SAINT PAUL",
"state": "MN",
"postal_code": "55105",
"telephone_number": "612-257-2391"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ZUPETZ",
"first_name": "SHIRLEY",
"middle_name": "CHRISTINE",
"credential": "LADC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-04-06",
"last_updated": "2020-04-06",
"certification_date": "2020-04-06",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "MN",
"license": "305471",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LADC LICENSE NUMBER",
"identifier": "305471",
"state": "MN"
}
],
"endpoints": [
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "Procentive",
"affiliation": "N",
"endpointDescription": "Medical Records",
"use": "HIE",
"useDescription": "Health Information Exchange (HIE)",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "Medical Records",
"address_1": "1137 Grand Ave",
"city": "Saint Paul",
"state": "MN",
"country_code": "US",
"postal_code": "55105",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": [
{
"first_name": "SHIRLEY",
"last_name": "MITCHELL",
"middle_name": "CHRISTINE",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Saint Paul, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.