Active NPI
Shirley Dian Bradshaw, L.M.H.C.
- Mental Health Counselor
- Satellite BCH, FL
National Provider Identifier
1679899744
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- MH 9333
- Practice address
- 1127 S Patrick Dr
#24
Satellite BCH, FL 32937-3939 - Phone
- (321) 773-1111
- NPI assigned
- Apr 14, 2010
- Last updated
- Jun 26, 2010
- 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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | MH 9333 | FL | Primary |
Addresses
Primary practice location
1127 S Patrick Dr
#24
Satellite BCH, FL 32937-3939
Mailing address
1127 S Patrick Dr
#24
Satellite BCH, FL 32937-3939
Phone (321) 773-1111
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MH 9333 | FL | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Progressive Counseling Centers Inc | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Brevard Outpatient Alternative Treatment
- Addiction (Substance Use Disorder) Counselor
- Satellite Beach, FL
- NPI 1275692204
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1271203200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1277510400000",
"number": "1679899744",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1127 S PATRICK DR",
"address_2": "#24",
"city": "SATELLITE BCH",
"state": "FL",
"postal_code": "329373939",
"telephone_number": "321-773-1111"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1127 S PATRICK DR",
"address_2": "#24",
"city": "SATELLITE BCH",
"state": "FL",
"postal_code": "329373939",
"telephone_number": "321-773-1111"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRADSHAW",
"first_name": "SHIRLEY",
"middle_name": "DIAN",
"credential": "L.M.H.C.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-04-14",
"last_updated": "2010-06-26",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "FL",
"license": "MH 9333",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Satellite BCH, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.