Amanda Renee Shackelford

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

205 S J T Stites Blvd
Sallisaw, OK 74955-9323

Phone

(918) 775-7787

Fax

(918) 775-0328

NPI assigned

Jul 15, 2013

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 AR

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

Clinical Social Worker

Education

Other, 2016

Medicare assignment

May accept Medicare assignment

Group practices

PT Concepts PLLCGroup PAC ID 1951669852, 25 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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.

• PT Concepts, PLLC

  • Mental Health Counselor
  • Rogers, AR
  • NPI 1164931291
  Medicare reassignment Care Compare group NPD
• My Therapy LLC

  • Mental Health Counselor
  • Rogers, AR
  • NPI 1598633091
  NPD (past)

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

{
    "created_epoch": "1373846400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1373846400000",
    "number": "1386085728",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "205 S J T STITES BLVD",
            "city": "SALLISAW",
            "state": "OK",
            "postal_code": "749559323",
            "telephone_number": "918-775-7787",
            "fax_number": "918-775-0328"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 S J T STITES BLVD",
            "city": "SALLISAW",
            "state": "OK",
            "postal_code": "749559323",
            "telephone_number": "918-775-7787",
            "fax_number": "918-775-0328"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHACKELFORD",
        "first_name": "AMANDA",
        "middle_name": "RENEE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-07-15",
        "last_updated": "2013-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sequoyah County-City of Sallisaw Hospital Authority
• Sequoyah Manor LLC
• Sequoyah Memorial Hospital
• Sequoyah Residential Mental Health Facility, Inc
• Jaime Severns
• Carry Shamblin
• Kelli Shankle
• Anna Marie Shepherd
• Pat Sikes
• Heather Silva

• Mental Health Counselor in Sallisaw, OK
• Providers in Sallisaw, OK by specialty
• Mental Health Counselor in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2013; 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.