Individual provider Active NPI

Shavon Mabry

  • Social Worker
  • Ashland, KY
National Provider Identifier
1396221941
Registry record updated Jul 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
License
253380 Issued in KY
Practice address
201 22ND St
Ashland, KY 41101-7803
Phone
(606) 324-1141
NPI assigned
Jul 17, 2018
Last updated
Jul 17, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X 253380 KY Primary

Addresses

Primary practice location

201 22ND St
Ashland, KY 41101-7803

Mailing address

PO Box 790
Ashland, KY 41105-0790
Phone (606) 329-8588

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
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

Enrollment IDStateProvider typePAC IDDetails
I20231108001728 KY Practitioner - Clinical Social Worker 5698122901 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Kentucky Counseling Center LLCGroup PAC ID 7618221300, 57 clinicians

Practice addresses (Care Compare)

1169 Eastern Pkwy
Suite 3328
Louisville, KY 40217-1415
Phone (855) 591-0092

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
253380KYMDSocial Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Kentucky Counseling Center, LLC CurrentSince Sep 11, 2023 Accepting new patients

Locations

1169 Eastern Pkwy
Ste 3328
Louisville, KY 40217
Phone (205) 914-2526

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1531785600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1531785600000",
    "number": "1396221941",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 790",
            "city": "ASHLAND",
            "state": "KY",
            "postal_code": "411050790",
            "telephone_number": "606-329-8588",
            "fax_number": "606-329-8195"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 22ND ST",
            "city": "ASHLAND",
            "state": "KY",
            "postal_code": "411017803",
            "telephone_number": "606-324-1141"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MABRY",
        "first_name": "SHAVON",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-07-17",
        "last_updated": "2018-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "KY",
            "license": "253380",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ashland, KY

Sources for this page

Verify at the official NPI Registry.