Shelley Rae Buck, MS, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

2003023383 Issued in MO

Practice address

904 S Campbell Ave
Springfield, MO 65806-3182

Phone

(417) 761-6410

NPI assigned

Jul 29, 2009

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

Other identifiers 1

Other names 1

• Shelley Rae Haney Former name

Medicare fee-for-service enrollment

Enrolled in MO

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

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

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.

• Burrell, Inc.

  • Community/Behavioral Health Agency
  • Springfield, MO
  • NPI 1275541740
  Medicare reassignment

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

{
    "created_epoch": "1248825600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1553126400000",
    "number": "1528299237",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1300 E BRADFORD PKWY",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658044264",
            "telephone_number": "417-761-5000",
            "fax_number": "417-761-5011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "904 S CAMPBELL AVE",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658063182",
            "telephone_number": "417-761-6410"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1300 E Bradford Pkwy",
            "address_purpose": "LOCATION",
            "city": "Springfield",
            "state": "MO",
            "postal_code": "658044264",
            "country_code": "US",
            "telephone_number": "417-761-5000",
            "fax_number": "417-761-5011",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BUCK",
        "first_name": "SHELLEY",
        "middle_name": "RAE",
        "credential": "MS, LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-07-29",
        "last_updated": "2019-03-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MO",
            "license": "2003023383",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "495526501",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHELLEY",
            "last_name": "HANEY",
            "middle_name": "RAE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• BSLC II
• Elizabeth Anne Buchanan, PLPC
• Joshua B Buchanan, PLPC
• Whitney Buchanan, NP
• Michael David Buchta
• Jeani Buckley, NP
• Jordan D Buckley, NP-C
• Kristen Marie Buckley, MS, LPC
• John W Buckner, MD
• Rose L Buckner, ED.D

• Professional Counselor in Springfield, MO
• Providers in Springfield, MO by specialty
• Professional Counselor in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2019; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.