Shane Ryan Kelsey, MS, LPC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

LPC-8949 Issued in ID

Practice address

531 E 5TH St
Burley, ID 83318-1469

Phone

(208) 678-3555

Fax

(208) 678-3556

NPI assigned

Jun 28, 2022

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

Practice roles

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.

• A Plus Solutions Center

  • Adolescent and Children Mental Health Clinic/Center
  • Burley, ID
  • NPI 1124372370
  NPD (past)

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

{
    "created_epoch": "1656374400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656374400000",
    "number": "1659003697",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "622 DETTERS RD",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "833014991",
            "telephone_number": "208-219-2378"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "531 E 5TH ST",
            "city": "BURLEY",
            "state": "ID",
            "postal_code": "833181469",
            "telephone_number": "208-678-3555",
            "fax_number": "208-678-3556"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELSEY",
        "first_name": "SHANE",
        "middle_name": "RYAN",
        "credential": "MS, LPC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-06-28",
        "last_updated": "2022-06-28",
        "certification_date": "2022-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "ID",
            "license": "LPC-8949",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• JRT Healthcare, Inc.
• Ellen K Judd, P.A.
• Justin D Ward DMD MSD PLLC
• K2Red L.L.C.
• Logan Kay, DMD
• Kevin D. Banner
• Michael P Klett, D.O.
• Kaity Kobayashi, PT, DPT, PCS
• Heidi Lee Koepnick, LPC
• Susan L Koepnick, LPC

• Mental Health Counselor in Burley, ID
• Providers in Burley, ID by specialty
• Mental Health Counselor in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 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.

Verify at the official NPI Registry.