Melissa Shane

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

3248 Vandever Ave
Pekin, IL 61554-6274

Phone

(309) 347-5579

NPI assigned

May 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 1

Addresses

Other identifiers 1

Other names 1

• Melissa Warren Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1620259200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620259200000",
    "number": "1639753676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3248 VANDEVER AVE",
            "city": "PEKIN",
            "state": "IL",
            "postal_code": "615546274",
            "telephone_number": "309-347-5579"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3248 VANDEVER AVE",
            "city": "PEKIN",
            "state": "IL",
            "postal_code": "615546274",
            "telephone_number": "309-347-5579"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHANE",
        "first_name": "MELISSA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-05-06",
        "last_updated": "2021-05-06",
        "certification_date": "2021-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAXONOMY",
            "identifier": "101YM0800X",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "scampen@tazwoodmhc.org",
            "affiliation": "N",
            "address_1": "3248 Vandever Ave",
            "city": "Pekin",
            "state": "IL",
            "country_code": "US",
            "postal_code": "615546274",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "MELISSA",
            "last_name": "WARREN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Timmothy Jay Schwartz, DDS
• Deborah Kay Scott, LSW
• Angela Serbin
• Page V Settles, MD
• Huma Shamim, MD
• Jessie Shanks, LMHC, LCPC
• Amanda Sharp-Potter
• Cory M Sharp, PA-C
• Timothy Dane Shelley, O.D.
• Alison Sherren, AU.D., CCC-A

• Mental Health Counselor in Pekin, IL
• Providers in Pekin, IL by specialty
• Mental Health Counselor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.