Individual provider Active NPI

Shandelle Hether-Gray, LMHC

  • Mental Health Counselor
  • Brooklyn, NY
National Provider Identifier
1548626336
Registry record updated Feb 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
008136 Issued in NY
Practice address
247 Prospect Ave Ste 4H
Brooklyn, NY 11215-8403
Phone
(347) 509-7127
Fax
(347) 391-0191
NPI assigned
Jan 8, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 28, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X P00514 NY
Mental Health Counselor 101YM0800X 008136 NY Primary

Addresses

Primary practice location

247 Prospect Ave Ste 4H
Brooklyn, NY 11215-8403

Mailing address

2324 W Joppa Rd Ste 410
Lutherville, MD 21093-4620
Phone (443) 446-4718

Other practice location 1

2502 86th St Fl 3
Brooklyn, NY 11214-4440
Phone (347) 509-7127

Other practice location 2

2324 W Joppa Rd Ste 410
Lutherville, MD 21093-4620
Phone (443) 446-4718

Other names 1

  • Mrs. Shandelle Hether Former name

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

LicenseStateTypeSpecialty
P00514NYMDMental Health Counselor
008136NYMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Center for Cognitive & Behavioral Change, LLC Current Accepting new patients
In Bloom Mental Health Counseling, LLC Mental Health CurrentSince Aug 9, 2020 Accepting new patients

Locations

2324 W Joppa Rd
Ste 410
Timonium, MD 21093
Phone (347) 509-7127

247 Prospect Ave
Ste 4H
Brooklyn, NY 11215
Phone (347) 509-7127

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1452211200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1677542400000",
    "number": "1548626336",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2324 W JOPPA RD STE 410",
            "city": "LUTHERVILLE",
            "state": "MD",
            "postal_code": "210934620",
            "telephone_number": "443-446-4718",
            "fax_number": "347-391-0191"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "247 PROSPECT AVE STE 4H",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112158403",
            "telephone_number": "347-509-7127",
            "fax_number": "347-391-0191"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2502 86th St Fl 3",
            "address_purpose": "LOCATION",
            "city": "Brooklyn",
            "state": "NY",
            "postal_code": "112144440",
            "country_code": "US",
            "telephone_number": "347-509-7127",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2324 W Joppa Rd Ste 410",
            "address_purpose": "LOCATION",
            "city": "Lutherville",
            "state": "MD",
            "postal_code": "210934620",
            "country_code": "US",
            "telephone_number": "443-446-4718",
            "fax_number": "347-391-0191",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HETHER-GRAY",
        "first_name": "SHANDELLE",
        "name_prefix": "Mrs.",
        "credential": "LMHC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-01-08",
        "last_updated": "2023-02-28",
        "certification_date": "2023-02-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NY",
            "license": "P00514",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NY",
            "license": "008136",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHANDELLE",
            "last_name": "HETHER",
            "prefix": "MRS.",
            "credential": "MHC-LP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Brooklyn, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2023; 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.