Kenneth L. Shields, LMHC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

39001242A Issued in IN

Practice address

11104 Parkview Circle Dr
Ste 110
Fort Wayne, IN 46845-1730

Phone

(260) 460-3203

Fax

(260) 460-3130

NPI assigned

Jul 1, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1120176000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1356480000000",
    "number": "1548267743",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11104 PARKVIEW CIRCLE DR",
            "address_2": "STE 110",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468451730",
            "telephone_number": "260-460-3203",
            "fax_number": "260-460-3130"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11104 PARKVIEW CIRCLE DR",
            "address_2": "STE 110",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468451730",
            "telephone_number": "260-460-3203",
            "fax_number": "260-460-3130"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHIELDS",
        "first_name": "KENNETH",
        "middle_name": "L.",
        "credential": "LMHC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-01",
        "last_updated": "2012-12-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IN",
            "license": "39001242A",
            "primary": true
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "IN",
            "license": "87001425A",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joseph Matthew Sherman, M.S., BCBA
• Richard Sherwood
• Rahul Ramesh Shetty, M.D.
• Shield Physical Therapy and Injury Prevention LLC
• Juli Jo Shields, CCC-SLP
• Shirley F Shiff, PSYD HSPP
• Kathi Shifferly, REGISTRED NURSE
• Eugene Yu Sheng Shih, M.D.
• Brian Shilts, MS, LMHC, CSAYC
• S. Christopher Shim, M.D.

• Mental Health Counselor in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Mental Health Counselor in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 26, 2012; 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.