Elizabeth Jo Sheridan, QMHP

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

A5285 Issued in OR

Practice address

1555 SW 35TH St
Corvallis, OR 97333-1130

Phone

(541) 757-5811

NPI assigned

Jun 18, 2012

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Stargazer Therapy LLC

  • Community/Behavioral Health Agency
  • Adair Village, OR
  • NPI 1235905027
  NPD Authorized official

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

{
    "created_epoch": "1339977600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1630022400000",
    "number": "1407119134",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7170 SE SARAH DR",
            "city": "ADAIR VILLAGE",
            "state": "OR",
            "postal_code": "973306576",
            "telephone_number": "503-539-6090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1555 SW 35TH ST",
            "city": "CORVALLIS",
            "state": "OR",
            "postal_code": "973331130",
            "telephone_number": "541-757-5811"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11456 NE Knott St",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972201706",
            "country_code": "US",
            "telephone_number": "503-736-6536",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHERIDAN",
        "first_name": "ELIZABETH",
        "middle_name": "JO",
        "name_prefix": "Mrs.",
        "credential": "QMHP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-06-18",
        "last_updated": "2021-08-27",
        "certification_date": "2021-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OR",
            "license": "A5285",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1407119134",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Andrew J Sheldon, MS
• Jonah Shell
• Quincey Shelton
• Carolyn Shepard, RPH
• Sharyn B Shepherd, FNP
• Eric Michael Sherrill
• Jo Anne Shields, CADC-II
• Judy L Shih, M.D. PH.D.
• Martha Christy Shimeall, MS
• Stephanie Naree Shippen, PSY.D.

• Mental Health Counselor in Corvallis, OR
• Providers in Corvallis, OR by specialty
• Mental Health Counselor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.