Active NPI
Kelli D Shaw, LADAC
- Addiction (Substance Use Disorder) Counselor
- Ruidoso, NM
National Provider Identifier
1487714382
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 3439
- Practice address
- 100 Warrior Drive
Ruidoso, NM 88345 - Phone
- (505) 258-4859
- Fax
- (505) 258-3320
- NPI assigned
- Dec 11, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 3439 | NM | Primary |
Addresses
Primary practice location
100 Warrior Drive
Ruidoso, NM 88345
Mailing address
1400 Sudderth Dr
Ruidoso, NM 88345-6103
Phone (505) 258-4859
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3439 | NM | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165795200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1487714382",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1400 SUDDERTH DR",
"city": "RUIDOSO",
"state": "NM",
"postal_code": "883456103",
"telephone_number": "505-258-4859",
"fax_number": "505-258-3320"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 WARRIOR DRIVE",
"city": "RUIDOSO",
"state": "NM",
"postal_code": "88345",
"telephone_number": "505-258-4859",
"fax_number": "505-258-3320"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHAW",
"first_name": "KELLI",
"middle_name": "D",
"name_prefix": "Ms.",
"credential": "LADAC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-12-11",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "NM",
"license": "3439",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ruidoso, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.