Active NPI
Brian Shannon, MA
- Professional Counselor
- Bend, OR
National Provider Identifier
1558722280
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- C7238
- Practice address
- 1133 NW Wall St Ste 6
Bend, OR 97703-1962 - Phone
- (541) 581-0394
- NPI assigned
- Mar 8, 2016
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | C7238 | OR | Primary |
Addresses
Primary practice location
1133 NW Wall St Ste 6
Bend, OR 97703-1962
Mailing address
2157 NW Quince CT
Redmond, OR 97756-7657
Phone (541) 581-0394
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
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C7238 | OR | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1457395200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1696464000000",
"number": "1558722280",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2157 NW QUINCE CT",
"city": "REDMOND",
"state": "OR",
"postal_code": "977567657",
"telephone_number": "541-581-0394"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1133 NW WALL ST STE 6",
"city": "BEND",
"state": "OR",
"postal_code": "977031962",
"telephone_number": "541-581-0394"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHANNON",
"first_name": "BRIAN",
"credential": "MA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-03-08",
"last_updated": "2023-10-05",
"certification_date": "2023-10-05",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Counselor, Professional",
"state": "OR",
"license": "C7238",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bend, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 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.