Individual provider Active NPI

Dustin Hayden Shedrick

  • Mental Health Counselor
  • La Junta, CO
National Provider Identifier
1669978417
Registry record updated Jun 20, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Practice address
711 Barnes Ave
La Junta, CO 81050-2138
Phone
(800) 511-5446
Fax
(719) 384-5672
NPI assigned
Apr 2, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 20, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X Primary

Addresses

Primary practice location

711 Barnes Ave
La Junta, CO 81050-2138

Mailing address

711 Barnes Ave
La Junta, CO 81050-2138
Phone (800) 511-5446

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250628000370 CO Practitioner - Mental Health Counselor 0345753885

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Valley-Wide Health Systems, Inc. CurrentSince Jun 20, 2025 Accepting new patients
Valley-Wide Health Systems, Inc CurrentSince Jun 20, 2025 Accepting new patients

Locations

128 Market St
Alamosa, CO 81101
Phone (719) 587-1001

1012 Belmont Ave
La Junta, CO 81050
Phone (719) 383-5500

711 Barnes Ave
La Junta, CO 81050
Phone 7193845446 ext. 338

245 Vine Ave
Las Animas, CO 81054
Phone (719) 456-1243

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1522627200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750377600000",
    "number": "1669978417",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "711 BARNES AVE",
            "city": "LA JUNTA",
            "state": "CO",
            "postal_code": "810502138",
            "telephone_number": "800-511-5446",
            "fax_number": "719-384-5672"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "711 BARNES AVE",
            "city": "LA JUNTA",
            "state": "CO",
            "postal_code": "810502138",
            "telephone_number": "800-511-5446",
            "fax_number": "719-384-5672"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHEDRICK",
        "first_name": "DUSTIN",
        "middle_name": "HAYDEN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-04-02",
        "last_updated": "2025-06-20",
        "certification_date": "2025-05-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in La Junta, CO

Sources for this page

Verify at the official NPI Registry.