Active NPI
Shellye Simpson Moon, LCSW
- Clinical Social Worker
- Austin, TX
National Provider Identifier
1629355144
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 50421
- Practice address
- 11604 Fletcher Hall LN
Austin, TX 78717-4451 - Phone
- (512) 825-5398
- Fax
- (512) 306-0740
- NPI assigned
- Nov 11, 2011
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 50421 | TX | Primary |
Addresses
Primary practice location
11604 Fletcher Hall LN
Austin, TX 78717-4451
Mailing address
11604 Fletcher Hall LN
Austin, TX 78717-4451
Phone (512) 825-5398
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 50421 | TX | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1320969600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1335225600000",
"number": "1629355144",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11604 FLETCHER HALL LN",
"city": "AUSTIN",
"state": "TX",
"postal_code": "787174451",
"telephone_number": "512-825-5398",
"fax_number": "512-306-0740"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11604 FLETCHER HALL LN",
"city": "AUSTIN",
"state": "TX",
"postal_code": "787174451",
"telephone_number": "512-825-5398",
"fax_number": "512-306-0740"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOON",
"first_name": "SHELLYE",
"middle_name": "SIMPSON",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-11-11",
"last_updated": "2012-04-24",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "TX",
"license": "50421",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Austin, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.