Shiode Psychotherapy, Inc.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PY0244 Issued in NV

Legal business name

SHIODE PSYCHOTHERAPY, INC.

Practice address

501 S. Rancho Dr.
Ste I-64
Las Vegas, NV 89106

Phone

(702) 384-4110

Fax

(702) 384-7954

NPI assigned

Mar 7, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Daniel T Shiode, PH.D.NPI 1013047091

Title

President

Phone

(702) 384-4110

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NV

Enrollment records 1

Locations

Practitioners 2

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

• Daniel T Shiode, PH.D.

  • Clinical Psychologist
  • Las Vegas, NV
  • NPI 1013047091
  Medicare reassignment NPD Authorized official
• Deena J Shiode, LCSW

  • Clinical Social Worker
  • Las Vegas, NV
  • NPI 1114057106
  NPD (past)

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

{
    "created_epoch": "1173225600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1245369600000",
    "number": "1326178310",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 S. RANCHO DR.",
            "address_2": "STE I-64",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "89106",
            "telephone_number": "702-384-4110",
            "fax_number": "702-384-7954"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 S. RANCHO DR.",
            "address_2": "STE I-64",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "89106",
            "telephone_number": "702-384-4110",
            "fax_number": "702-384-7954"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHIODE PSYCHOTHERAPY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-07",
        "last_updated": "2009-06-19",
        "status": "A",
        "authorized_official_last_name": "SHIODE",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "702-384-4110",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "NV",
            "license": "PY0244",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002602062",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shining Light Counseling LLC
• Shining Light LLC
• Shining Minds LTD
• Shining Star Community Services
• Shining Star Community Services
• Daniel T Shiode, PH.D.
• Deena J Shiode, LCSW
• Marisa Fumiye Shiode, M.D.
• Linda Shipman
• Shelly Shipman, RN

• Clinical Psychologist in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Clinical Psychologist in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.