Active NPI
Shannon Kellim Young, LP, LCSW
- Counseling Psychologist
- Eugene, OR
National Provider Identifier
1750511408
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counseling Psychologist
- License
- 2298
- Practice address
- 1210 Pearl St
Eugene, OR 97401-3573 - Phone
- (541) 344-5440
- NPI assigned
- Jul 15, 2009
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 4454 | OR | |
| Counseling Psychologist | 103TC1900X | 2298 | OR | Primary |
Addresses
Primary practice location
1210 Pearl St
Eugene, OR 97401-3573
Mailing address
1210 Pearl St
Eugene, OR 97401-3573
Phone (541) 344-5440
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 |
|---|---|---|---|
| 4454 | OR | MD | Specialist |
| 2298 | OR | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1247616000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1731456000000",
"number": "1750511408",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1210 PEARL ST",
"city": "EUGENE",
"state": "OR",
"postal_code": "974013573",
"telephone_number": "541-344-5440"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1210 PEARL ST",
"city": "EUGENE",
"state": "OR",
"postal_code": "974013573",
"telephone_number": "541-344-5440"
}
],
"practiceLocations": [],
"basic": {
"last_name": "YOUNG",
"first_name": "SHANNON",
"middle_name": "KELLIM",
"name_prefix": "Dr.",
"credential": "LP, LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-07-15",
"last_updated": "2024-11-13",
"certification_date": "2024-11-13",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "OR",
"license": "4454",
"primary": false
},
{
"code": "103TC1900X",
"taxonomy_group": "",
"desc": "Psychologist, Counseling",
"state": "OR",
"license": "2298",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Eugene, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.