Active NPI
Patricia Shannon, LPC
- Professional Counselor
- Medford, OR
National Provider Identifier
1629240205
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- C4048
- Practice address
- 900 E Main St
Medford, OR 97504-7136 - Phone
- (541) 500-0977
- NPI assigned
- Mar 24, 2008
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | C4048 | OR | Primary |
Addresses
Primary practice location
900 E Main St
Medford, OR 97504-7136
Mailing address
1221 Disk Dr
Medford, OR 97501-6638
Phone (541) 733-3683
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 |
|---|---|---|---|
| C4048 | OR | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Columbiacare Services Inc | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Medford, OR
- NPI 1861942096
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1206316800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1687824000000",
"number": "1629240205",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1221 DISK DR",
"city": "MEDFORD",
"state": "OR",
"postal_code": "975016638",
"telephone_number": "541-733-3683",
"fax_number": "541-842-7640"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "900 E MAIN ST",
"city": "MEDFORD",
"state": "OR",
"postal_code": "975047136",
"telephone_number": "541-500-0977"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHANNON",
"first_name": "PATRICIA",
"credential": "LPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-03-24",
"last_updated": "2023-06-27",
"certification_date": "2023-06-27",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "OR",
"license": "C4048",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Medford, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 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.