Kelly Shannon, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

2-3034 Issued in TX

Practice address

102 E Mulberry Ave
San Antonio, TX 78212-2946

Phone

(210) 279-1516

Fax

(210) 733-0141

NPI assigned

Sep 21, 2006

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

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in TX

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

Specialty

Clinical Psychologist

Education

Other, 1979

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

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.

• Cristo Rey Clinic, PA

  • Internal Medicine Physician
  • San Antonio, TX
  • NPI 1316067903
  NPD (past)
• Rosa Verde Family Health Group

  dba Rosa Verde Behavioral Health

  • Marriage & Family Therapist
  • San Antonio, TX
  • NPI 1588774582

  Clinical

  NPD (past)

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

{
    "created_epoch": "1158796800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1237852800000",
    "number": "1699874198",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 120041",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782129241",
            "telephone_number": "210-279-1516",
            "fax_number": "210-733-0141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 E MULBERRY AVE",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782122946",
            "telephone_number": "210-279-1516",
            "fax_number": "210-733-0141"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHANNON",
        "first_name": "KELLY",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-21",
        "last_updated": "2009-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "TX",
            "license": "2-3034",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS - TX",
            "identifier": "H00088RY01",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "035931704",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Melvin Lee Shanley, DDS
• Robyn Shanley, AUD, PHD
• Shannon Monnig Nelson, Ms, LMFT, CCLS, PLLC
• Cassandra M Shannon
• Jennifer Anne Shannon, PTA
• Nick H Shannon, MD
• Katherine Shao, D.D.S.
• Shaping Little Steps
• Erica Rosentraub Shapiro, PH.D.
• Jonathan Shapiro

• Clinical Psychologist in San Antonio, TX
• Providers in San Antonio, TX by specialty
• Clinical Psychologist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2009; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.