Active NPI
Jay Shuck, LPCA
- Mental Health Counselor
- Owensboro, KY
National Provider Identifier
1619084852
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 1062N
- Practice address
- 2720 Frederica St
Owensboro, KY 42301-5442 - Phone
- (270) 926-2484
- NPI assigned
- Aug 24, 2006
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 1062N | KY | Primary |
Addresses
Primary practice location
2720 Frederica St
Owensboro, KY 42301-5442
Mailing address
PO Box 1429
Mt Washington, KY 40047-1429
Phone (877) 992-5242
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
| License | State | Type | Specialty |
|---|---|---|---|
| 1062N | KY | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156377600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1365465600000",
"number": "1619084852",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1429",
"city": "MT WASHINGTON",
"state": "KY",
"postal_code": "400471429",
"telephone_number": "877-992-5242"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2720 FREDERICA ST",
"city": "OWENSBORO",
"state": "KY",
"postal_code": "423015442",
"telephone_number": "270-926-2484"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHUCK",
"first_name": "JAY",
"name_prefix": "Mr.",
"credential": "LPCA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-24",
"last_updated": "2013-04-09",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "KY",
"license": "1062N",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Owensboro, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.