NPIMap

Organization Active NPI

Shanlis, Inc.

  • Clinical Psychologist
  • Stuart, FL
National Provider Identifier
1700214459
Registry record updated Oct 10, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PY5917 Issued in FL
Legal business name
SHANLIS, INC.
Practice address
744 Colroado Ave
Stuart, FL 34994-2918
Phone
(772) 223-9988
Fax
(772) 223-9593
NPI assigned
Oct 16, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2016

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

Authorized official

Name
Dr. Theodore G Williams, PH.D.
Title
Clinical Director
Phone
(772) 223-9988

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X PY5917 FL Primary

Addresses

Primary practice location

744 Colroado Ave
Stuart, FL 34994-2918

Mailing address

744 Colroado Ave
Stuart, FL 34994-2918
Phone (772) 223-9988

National Provider Directory

National Provider Directory
Tax ID family
Shanlis Counseling Assessment Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1381881600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1476057600000",
    "number": "1700214459",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "744 COLROADO AVE",
            "city": "STUART",
            "state": "FL",
            "postal_code": "349942918",
            "telephone_number": "772-223-9988",
            "fax_number": "772-223-9593"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "744 COLROADO AVE",
            "city": "STUART",
            "state": "FL",
            "postal_code": "349942918",
            "telephone_number": "772-223-9988",
            "fax_number": "772-223-9593"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHANLIS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-16",
        "last_updated": "2016-10-10",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "THEODORE",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "772-223-9988",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "FL",
            "license": "PY5917",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Stuart, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 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.

Verify at the official NPI Registry.