Shelly Denise Champagne, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

3040 Issued in KY

Practice address

1300 Andrea St Ste 205
Bowling Green, KY 42104-3382

Phone

(270) 205-4585

Fax

(270) 936-7333

NPI assigned

Apr 9, 2012

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

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

Specialty

Clinical Social Worker

Education

University of Louisville School of Medicine, 2006

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Alliance Counseling AssociatesGroup PAC ID 9436443736, 11 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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.

• Alliance Counseling Associates

  • Mental Health Counselor
  • Glasgow, KY
  • NPI 1285938209

  Clinical

  Medicare reassignment Care Compare group NPD
• Alliance Center for Community Empowerment and Support Services, LLC

  dba Access

  • Community/Behavioral Health Agency
  • Glasgow, KY
  • NPI 1245635796
  NPD (past)

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

{
    "created_epoch": "1333929600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1548526049",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 REYNOLDS RD",
            "city": "GLASGOW",
            "state": "KY",
            "postal_code": "421411177",
            "telephone_number": "270-904-6567",
            "fax_number": "270-904-6570"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 ANDREA ST STE 205",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421043382",
            "telephone_number": "270-205-4585",
            "fax_number": "270-936-7333"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1910 Lyda Ave",
            "address_purpose": "LOCATION",
            "city": "Bowling Green",
            "state": "KY",
            "postal_code": "421043326",
            "country_code": "US",
            "telephone_number": "270-904-6567",
            "fax_number": "270-904-6570",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CHAMPAGNE",
        "first_name": "SHELLY",
        "middle_name": "DENISE",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-04-09",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "KY",
            "license": "3040",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Leyna Centers
• Central Kentucky Mobility of Bowling Green, LLC
• Kinlee Chaffin
• Chambers & Clark Hearing LLC (Chambrs & Clark Hearing Aid Service)
• Amber Chambers, MD
• Deborah Kay Champion, M.A., LPCC,
• Amanda Chandler, LPCA
• Christopher G. Chandler
• Madelene B Chandler, LPA
• Mindy Chandler, APRN

• Clinical Social Worker in Bowling Green, KY
• Providers in Bowling Green, KY by specialty
• Clinical Social Worker in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.