Shelby Lynn Patrick, M. ED, LPCC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

E.2102281 Issued in OH

Practice address

1071 Tong Hollow Rd
Bainbridge, OH 45612-1500

Phone

(740) 634-3094

NPI assigned

May 14, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Education

State licenses

Practice roles

Interoperability endpoints

• FHIR API: https://api.qualifacts.org/api/fhir/lys/r4/

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Lighthouse Youth Services Inc.

  dba Lighthouse Youth & Family Services

  • Addiction (Substance Use Disorder) Counselor
  • Bainbridge, OH
  • NPI 1053389841
  NPD (past)

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

{
    "created_epoch": "1526256000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621382400000",
    "number": "1770073983",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 E MCMILLAN ST",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452061922",
            "telephone_number": "513-221-3350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1071 TONG HOLLOW RD",
            "city": "BAINBRIDGE",
            "state": "OH",
            "postal_code": "456121500",
            "telephone_number": "740-634-3094"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PATRICK",
        "first_name": "SHELBY",
        "middle_name": "LYNN",
        "credential": "M. ED, LPCC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-05-14",
        "last_updated": "2021-05-19",
        "certification_date": "2021-05-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "OH",
            "license": "E.2102281",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carrie Oliver
• John Orr, CDCA,QMHS
• Paint Valley Local School District
• Charles Adam Pate
• Rebecca Lynn Pate
• Paxton Township Ttees (Paxton Township Area Life Squad)
• Loretta Mae Penwell, LPN
• Paul Penwell, CDCA, QMHS
• April Peters, LPN
• Premise Health of Ohio Medical PA (Scioto Advantage - Bainbridge)

• Professional Counselor in Bainbridge, OH
• Providers in Bainbridge, OH by specialty
• Professional Counselor in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2021; 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.