Susan Marie Shaw, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

6401224006 Issued in MI

Practice address

127 North River Street
Fenton, MI 48430

Phone

(810) 309-9355

NPI assigned

Aug 12, 2013

Last updated

Jul 14, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: susan.shaw.1@28621.direct.athenahealth.com

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.

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  • NPI 1033729603
  Medicare reassignment NPD
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  • NPI 1386964278

  Counselor

  NPD (past)
• J Flack PSYD PC

  dba Fenton Wellness

  • Psychologist
  • Fenton, MI
  • NPI 1770859001

  Counselor

  NPD (past)

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

{
    "created_epoch": "1376265600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720915200000",
    "number": "1679906879",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6102 WESTDALE DR",
            "city": "GRAND BLANC",
            "state": "MI",
            "postal_code": "484398512",
            "telephone_number": "810-813-2113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "127 NORTH RIVER STREET",
            "city": "FENTON",
            "state": "MI",
            "postal_code": "48430",
            "telephone_number": "810-309-9355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAW",
        "first_name": "SUSAN",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-08-12",
        "last_updated": "2024-07-14",
        "certification_date": "2024-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "MI",
            "license": "6401013785",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MI",
            "license": "6401224006",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Serenity Recovery Services LLC
• Seven Lakes Periodontics
• Michelle Ann Sgalia, D.D.S.
• Marc Kenneth Shaeffer
• My Le Shaw, M.D.
• Darcy Shay, FNP
• Madison Shegos, PA-C
• Amy Ruth Shepard, D.O.
• Thomas Showerman, DPT
• Avani Shukla, PHARMD

• Professional Counselor in Fenton, MI
• Providers in Fenton, MI by specialty
• Professional Counselor in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.