Active NPI
Paul E Shelley, MSW, LCSW
- Mental Health Counselor
- Elkhart, IN
National Provider Identifier
1689703464
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 34003756A
- Practice address
- 1506 Osolo Rd
Suite a
Elkhart, IN 46514-4122 - Phone
- (574) 523-3347
- Fax
- (574) 296-7560
- NPI assigned
- Mar 5, 2007
- Sex
- Male
- Sole proprietor
- No
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 | 34003756A | IN | Primary |
Addresses
Primary practice location
1506 Osolo Rd
Suite a
Elkhart, IN 46514-4122
Mailing address
710 N Niles Ave
South Bend, IN 46617-1924
Phone (574) 647-1610
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000000520385 | Other | IN | ANTHEM BCBS # |
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)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| McArthur Mental Health Services | Mental Health | 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 and National Provider Directory roles.
-
- Addiction (Substance Use Disorder) Counselor
- Warsaw, IN
- NPI 1386058428
Mental Health
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173052800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1463443200000",
"number": "1689703464",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "710 N NILES AVE",
"city": "SOUTH BEND",
"state": "IN",
"postal_code": "466171924",
"telephone_number": "574-647-1610",
"fax_number": "574-237-6069"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1506 OSOLO RD",
"address_2": "SUITE A",
"city": "ELKHART",
"state": "IN",
"postal_code": "465144122",
"telephone_number": "574-523-3347",
"fax_number": "574-296-7560"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHELLEY",
"first_name": "PAUL",
"middle_name": "E",
"name_prefix": "Mr.",
"credential": "MSW, LCSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-03-05",
"last_updated": "2016-05-17",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "IN",
"license": "34003756A",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM BCBS #",
"identifier": "000000520385",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Elkhart, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.