Active NPI
Spencer E Shotley, LADC, CADC III
- Addiction (Substance Use Disorder) Counselor
- Cass Lake, MN
National Provider Identifier
1740560804
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 302091
- Practice address
- 115 6TH Street NW
Cass Lake, MN 56633 - Phone
- (218) 760-9257
- NPI assigned
- Aug 22, 2011
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 302091 | MN | Primary |
Addresses
Primary practice location
115 6TH Street NW
Cass Lake, MN 56633
Mailing address
115 6TH Street NW
Cass Lake, MN 56633
Phone (218) 760-9257
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 |
|---|---|---|---|
| 302091 | MN | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1313971200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1313971200000",
"number": "1740560804",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "115 6TH STREET NW",
"city": "CASS LAKE",
"state": "MN",
"postal_code": "56633",
"telephone_number": "218-760-9257"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "115 6TH STREET NW",
"city": "CASS LAKE",
"state": "MN",
"postal_code": "56633",
"telephone_number": "218-760-9257"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHOTLEY",
"first_name": "SPENCER",
"middle_name": "E",
"credential": "LADC, CADC III",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-08-22",
"last_updated": "2011-08-22",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "MN",
"license": "302091",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cass Lake, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.