Shannon Nicole Ellison

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

KY-1355 Issued in KY

Practice address

3121 Brooklawn Campus Dr
Louisville, KY 40218-1282

Phone

(502) 451-5177

NPI assigned

Jan 31, 2014

Last updated

Jan 31, 2014By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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 KY, CO, VA3 enrollments

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 3

Specialty

Mental Health Counselor

Education

Other, 2006

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Talkspace Provider Network PAGroup PAC ID 5799136701, 249 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.

• Talkspace Provider Network PA

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • New York, NY
  • NPI 1639814049

  KY, VA

  Medicare reassignment Care Compare group NPD
• Talkspace Provider Network Co, PC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • New York, NY
  • NPI 1518747385

  CO

  Medicare reassignment NPD
• Barrett Simpson, O.D. LLC

  • Optometrist
  • Bowling Green, KY
  • NPI 1225252943
  NPD (past)
• Resilient Life Counseling Services, PLLC

  • Professional Counselor
  • Colorado Springs, CO
  • NPI 1497460901
  NPD (past)

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

{
    "created_epoch": "1391126400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1391126400000",
    "number": "1437572146",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4532 PULASKI CT",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402451839"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3121 BROOKLAWN CAMPUS DR",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402181282",
            "telephone_number": "502-451-5177"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLISON",
        "first_name": "SHANNON",
        "middle_name": "NICOLE",
        "name_prefix": "Mrs.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-01-31",
        "last_updated": "2014-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "KY",
            "license": "KY-1355",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rudy John Ellis Jr., MD
• Shanna Ellis, RN
• Elizabeth Caroline Ellison-Brown, APRN
• Amanda Rebecca Ellison, DPT
• Kaitlyn L Ellison, RBT
• Stacy Brian Ellison, D.M.D.
• Katelin H Elm, APRN
• Rifaat S Elmallakh, M.D.
• Elmcroft of Sherwood
• Stacey Charlotte Elmes, BA

• Professional Counselor in Louisville, KY
• Providers in Louisville, KY by specialty
• Professional Counselor in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2014; 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.