Active NPI
Shawn Keith Hartzog, LPA
- Psychologist
- Sylva, NC
National Provider Identifier
1629104641
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 2262
- Practice address
- 154 Medical Park Loop
Sylva, NC 28779-5271 - Phone
- (828) 319-1080
- Fax
- (828) 631-9280
- NPI assigned
- Feb 26, 2007
- 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 7
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 2262 | NC | |
| Psychologist | 103T00000X | 2262 | NC | Primary |
| Clinical Child & Adolescent Psychologist | 103TC2200X | 2262 | NC | |
| Family Psychologist | 103TF0000X | 2262 | NC | |
| Health Service Psychologist | 103TH0100X | 2262 | NC | |
| Group Psychotherapy Psychologist | 103TP2701X | 2262 | NC | |
| Forensic Psychologist | 103TF0200X | 2262 | NC |
Addresses
Primary practice location
154 Medical Park Loop
Sylva, NC 28779-5271
Mailing address
154 Medical Park Loop
Sylva, NC 28779-5271
Phone (828) 319-1080
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6107428 | Medicaid | NC |
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 |
|---|---|---|---|
| 2262 | NC | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172448000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1271635200000",
"number": "1629104641",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "154 MEDICAL PARK LOOP",
"city": "SYLVA",
"state": "NC",
"postal_code": "287795271",
"telephone_number": "828-319-1080",
"fax_number": "828-631-9280"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "154 MEDICAL PARK LOOP",
"city": "SYLVA",
"state": "NC",
"postal_code": "287795271",
"telephone_number": "828-319-1080",
"fax_number": "828-631-9280"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HARTZOG",
"first_name": "SHAWN",
"middle_name": "KEITH",
"name_prefix": "Mr.",
"credential": "LPA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-02-26",
"last_updated": "2010-04-19",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "NC",
"license": "2262",
"primary": false
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "NC",
"license": "2262",
"primary": true
},
{
"code": "103TC2200X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": "NC",
"license": "2262",
"primary": false
},
{
"code": "103TF0000X",
"taxonomy_group": "",
"desc": "Psychologist, Family",
"state": "NC",
"license": "2262",
"primary": false
},
{
"code": "103TH0100X",
"taxonomy_group": "",
"desc": "Psychologist, Health Service",
"state": "NC",
"license": "2262",
"primary": false
},
{
"code": "103TP2701X",
"taxonomy_group": "",
"desc": "Psychologist, Group Psychotherapy",
"state": "NC",
"license": "2262",
"primary": false
},
{
"code": "103TF0200X",
"taxonomy_group": "",
"desc": "Psychologist, Forensic",
"state": "NC",
"license": "2262",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "6107428",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Sylva, NC
- Harris Regional Hospital, Inc.
- Harris Regional Hospital, Inc.
- Harris Regional Hospital, Inc.
- Brittany Courtney Harris, NP-C
- Brandi Ann Harrison, IBCLC
- Shannon Nicole Haskett, PT
- Stefanie Kam Hatfield, M.D.
- Heart of the Community, Inc.
- Terry W Heatherington, PHARMACIST
- Katherine Carpenter Hefner, FNP-C
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.