Carly Blake Shannon, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

62456 Issued in TX

Practice address

4144 N Central Expy Ste 850
Dallas, TX 75204-3226

Phone

(512) 956-6463

Fax

(866) 653-5142

NPI assigned

Nov 20, 2008

Last updated

Sep 18, 2025By the provider in NPPES

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 TX

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

University of North Texas HSC, College of Osteopathic Med, 2006

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Deep Eddy Psychotherapy Management, LLCGroup PAC ID 2264886936, 70 clinicians

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Deep Eddy Psychotherapy Management, LLC

  • Counseling Psychologist
  • Austin, TX
  • NPI 1457740862
  Medicare reassignment Care Compare group NPD
• Deep Centered Psychiatry PLLC

  • Psychiatry Physician
  • Austin, TX
  • NPI 1629853825
  NPD (past)
• Kearley & Schmitt PLLC

  • Clinical Social Worker
  • Austin, TX
  • NPI 1063522498
  NPD (past)

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

{
    "created_epoch": "1227139200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1758153600000",
    "number": "1407001258",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5109 HOLY SPRINGS RD",
            "city": "DENTON",
            "state": "TX",
            "postal_code": "762074237",
            "telephone_number": "512-897-2709"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4144 N CENTRAL EXPY STE 850",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752043226",
            "telephone_number": "512-956-6463",
            "fax_number": "866-653-5142"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHANNON",
        "first_name": "CARLY",
        "middle_name": "BLAKE",
        "name_prefix": "Mrs.",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-11-20",
        "last_updated": "2025-09-18",
        "certification_date": "2025-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "TX",
            "license": "62456",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ashwin Kumar Shankar, DO
• Nila Shankar
• Rohan Shankar, MD
• Carolyn Shanks, MD
• Hari Priya Shanmugam, MD
• David Shannon
• Donelson Neal Shannon, MD
• Heather Parkey Shannon
• Kacie Marie Shannon
• Michael D. Shannon, D.O.

• Professional Counselor in Dallas, TX
• Providers in Dallas, TX by specialty
• Professional Counselor in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2025; 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.