Shelly Mae Johnson, L.P.C.C.

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

E.1300335 Issued in OH

Practice address

113 S Beech St
Bryan, OH 43506-1602

Phone

(419) 212-5938

Fax

(419) 784-2255

NPI assigned

Jul 19, 2014

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 OH

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, 2015

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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 and National Provider Directory roles.

• Inspiring Hope Counseling LLC

  • Professional Counselor
  • Bryan, OH
  • NPI 1184243388
  Medicare reassignment NPD Authorized official
• Shalom Ministries

  • Community/Behavioral Health Agency
  • Archbold, OH
  • NPI 1366573552
  NPD (past)

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

{
    "created_epoch": "1405728000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1575936000000",
    "number": "1326455510",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "113 S BEECH ST",
            "city": "BRYAN",
            "state": "OH",
            "postal_code": "435061602",
            "telephone_number": "419-212-5938",
            "fax_number": "419-754-2255"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "113 S BEECH ST",
            "city": "BRYAN",
            "state": "OH",
            "postal_code": "435061602",
            "telephone_number": "419-212-5938",
            "fax_number": "419-784-2255"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "SHELLY",
        "middle_name": "MAE",
        "credential": "L.P.C.C.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-07-19",
        "last_updated": "2019-12-10",
        "certification_date": "2019-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "OH",
            "license": "E.1300335",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• In Touch Therapeutic Massage, LLC
• Inspiring Hope Counseling LLC
• Ashlee N Johnson
• Jennifer Johnson, COTA
• Natasha Eileen Johnson, MA, COBA
• Cynthia Lee Jones, OTR/L
• Amelia Julio, CRNA
• Anthony Donald Kaminsky, DO
• Ioanna Kanellitsas, MD
• Emily Karnes

• Professional Counselor in Bryan, OH
• Providers in Bryan, OH by specialty
• Professional Counselor in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2019; 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.