Active NPI
Wesley Shattuck, M.ED., LCMHC
- Mental Health Counselor
- Londonderry, NH
National Provider Identifier
1356440648
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 157
- Practice address
- 226 Rockingham Rd
Londonderry, NH 03053-2107 - Phone
- (603) 425-2989
- Fax
- (603) 425-2978
- NPI assigned
- Sep 22, 2006
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 157 | NH | Primary |
Addresses
Primary practice location
226 Rockingham Rd
Londonderry, NH 03053-2107
Mailing address
226 Rockingham Rd
Londonderry, NH 03053-2107
Phone (603) 425-2989
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1409478Y0NH01 | Other | NH | BLUE CROSS BLUE SHIELD NH |
| 30423041 | Medicaid | NH |
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
- Credentials
- Master of Education
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 157 | NH | MD | Podiatrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158883200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1333584000000",
"number": "1356440648",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "226 ROCKINGHAM RD",
"city": "LONDONDERRY",
"state": "NH",
"postal_code": "030532107",
"telephone_number": "603-425-2989",
"fax_number": "603-425-2978"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "226 ROCKINGHAM RD",
"city": "LONDONDERRY",
"state": "NH",
"postal_code": "030532107",
"telephone_number": "603-425-2989",
"fax_number": "603-425-2978"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHATTUCK",
"first_name": "WESLEY",
"credential": "M.ED., LCMHC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-22",
"last_updated": "2012-04-05",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "NH",
"license": "157",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD NH",
"identifier": "1409478Y0NH01",
"state": "NH"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "30423041",
"state": "NH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Londonderry, NH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.