Shannon Lee Kossick, LCSW, LCADC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

11331-C Issued in NV

Practice address

777 E William St Ste 108
Carson City, NV 89701-4057

Phone

(775) 400-2660

NPI assigned

Oct 6, 2021

Sex

Female

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

Opted out of Medicare

Yes, effective Jun 5, 2025 through Jun 5, 2027

Medicare enrollment (NPD)

Enrolled

State licenses

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 and National Provider Directory roles.

• The Mindful Goldfish LLC

  • Clinical Social Worker
  • Carson City, NV
  • NPI 1780560482
  NPD Authorized official
• Carson City Community Counseling Center

  • Addiction (Substance Use Disorder) Counselor
  • Carson City, NV
  • NPI 1023253267
  NPD (past)
• Carson City Community Counseling Center

  • Community/Behavioral Health Agency
  • Carson City, NV
  • NPI 1659913978

  Addiction (Substance Use Disorder)

  NPD (past)

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

{
    "created_epoch": "1633478400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1774137600000",
    "number": "1619639762",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1944 MOLLY DR",
            "city": "CARSON CITY",
            "state": "NV",
            "postal_code": "897062643",
            "telephone_number": "916-751-9899"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "777 E WILLIAM ST STE 108",
            "city": "CARSON CITY",
            "state": "NV",
            "postal_code": "897014057",
            "telephone_number": "775-400-2660"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1944 Molly Dr",
            "address_purpose": "LOCATION",
            "city": "Carson City",
            "state": "NV",
            "postal_code": "897062643",
            "country_code": "US",
            "telephone_number": "775-400-2660",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KOSSICK",
        "first_name": "SHANNON",
        "middle_name": "LEE",
        "credential": "LCSW, LCADC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-10-06",
        "last_updated": "2026-03-22",
        "certification_date": "2026-03-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NV",
            "license": "08156-LC",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NV",
            "license": "11331-C",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Varun Kohli, MD
• Kristopher Lee Komarek, LCSW
• Kona Chiropractic LLC
• Sheldon M Kop, MD
• Kristin Nicole Koskela, M.D.
• Susan Jacqueline Kotler, PH.D, ABPP/ABCN
• Anita Kotrlik
• Tristan Kountz
• David John Kowalek, BVMS
• Gail P Krivan, M.D.

• Clinical Social Worker in Carson City, NV
• Providers in Carson City, NV by specialty
• Clinical Social Worker in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.