Active NPI
Karissa V.L. Delorme-Shives, MA, LPCC
- Professional Counselor
- Dayton, OH
National Provider Identifier
1639684590
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- E.2002043
- Practice address
- 2555 S Dixie Dr Ste 260
Dayton, OH 45409 - Phone
- (937) 853-9061
- NPI assigned
- Dec 13, 2017
- 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 |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | E.2002043 | OH | Primary |
Addresses
Primary practice location
2555 S Dixie Dr Ste 260
Dayton, OH 45409
Mailing address
10100 Elida Rd
Delphos, OH 45833-9056
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
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| E.2002043 | OH | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1513123200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1650412800000",
"number": "1639684590",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10100 ELIDA RD",
"city": "DELPHOS",
"state": "OH",
"postal_code": "458339056"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2555 S DIXIE DR STE 260",
"city": "DAYTON",
"state": "OH",
"postal_code": "45409",
"telephone_number": "937-853-9061"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DELORME-SHIVES",
"first_name": "KARISSA",
"middle_name": "V.L.",
"credential": "MA, LPCC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-12-13",
"last_updated": "2022-04-20",
"certification_date": "2022-04-20",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "OH",
"license": "E.2002043",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dayton, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.