Active NPI
Ethan Shane Hennesey, LPC-S
- Mental Health Counselor
- Richmond, TX
National Provider Identifier
1760249361
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 13364
- Practice address
- 406 Edgewood Dr
Richmond, TX 77406-4010 - Phone
- (281) 726-3027
- NPI assigned
- Mar 1, 2024
- 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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 13364 | TX | Primary |
Addresses
Primary practice location
406 Edgewood Dr
Richmond, TX 77406-4010
Mailing address
406 Edgewood Dr
Richmond, TX 77406-4010
Phone (281) 726-3027
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Mar 3, 2024 through Mar 3, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1709251200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1709251200000",
"number": "1760249361",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "406 EDGEWOOD DR",
"city": "RICHMOND",
"state": "TX",
"postal_code": "774064010",
"telephone_number": "281-726-3027"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "406 EDGEWOOD DR",
"city": "RICHMOND",
"state": "TX",
"postal_code": "774064010",
"telephone_number": "281-726-3027"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HENNESEY",
"first_name": "ETHAN",
"middle_name": "SHANE",
"name_prefix": "Mr.",
"credential": "LPC-S",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2024-03-01",
"last_updated": "2024-03-01",
"certification_date": "2024-03-01",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "TX",
"license": "13364",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Richmond, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.