Shelley Eileen Davis, CADC I, QMHA

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

Practice address

960 Liberty St SE Ste 120
Salem, OR 97302-4165

Phone

(503) 588-2804

Fax

(503) 371-6743

NPI assigned

Jan 4, 2016

Last updated

Sep 18, 2023By 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 2

Addresses

Other names 1

• Shelley Eileen Enquist/Blake Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

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.

• Serenity Lane

  • Substance Abuse Rehabilitation Facility
  • Coburg, OR
  • NPI 1104934892
  NPD (past)

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

{
    "created_epoch": "1451865600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694995200000",
    "number": "1417313677",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4691 WESTLAWN CT SE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973175541",
            "telephone_number": "971-240-3227"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "960 LIBERTY ST SE STE 120",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973024165",
            "telephone_number": "503-588-2804",
            "fax_number": "503-371-6743"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "SHELLEY",
        "middle_name": "EILEEN",
        "credential": "CADC I, QMHA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-01-04",
        "last_updated": "2023-09-18",
        "certification_date": "2023-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OR",
            "license": "17-10-21",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHELLEY",
            "last_name": "ENQUIST/BLAKE",
            "middle_name": "EILEEN",
            "credential": "SHELLEY E BLAKE",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Matthew Davis, P.T.
• Morgan Davis
• Patricia Marie Davis, CADC II, QMHA
• Peter Christopher Davis Jr., L.C.S.W.
• Sheila Davis
• Stephenie Saint Davis, LPC
• William W Davis, PSY D CLINICAL PSYCH
• Whitney Dawkins
• Amanda Elspeth Day
• Emily Irene Day

• Addiction (Substance Use Disorder) Counselor in Salem, OR
• Providers in Salem, OR by specialty
• Addiction (Substance Use Disorder) Counselor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2023; 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.