Active NPI
Thomas Shipley
- Mental Health Counselor
- Melbourne, FL
National Provider Identifier
1831579580
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- IMH8119
- Practice address
- 6808 Raccoon CT
Melbourne, FL 32940-6869 - Phone
- (321) 693-1383
- NPI assigned
- Jun 8, 2015
- 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 | IMH8119 | FL | Primary |
Addresses
Primary practice location
6808 Raccoon CT
Melbourne, FL 32940-6869
Mailing address
6808 Raccoon CT
Melbourne, FL 32940-6869
Phone (321) 693-1383
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 |
|---|---|---|---|
| IMH8119 | FL | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1433721600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1433721600000",
"number": "1831579580",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6808 RACCOON CT",
"city": "MELBOURNE",
"state": "FL",
"postal_code": "329406869",
"telephone_number": "321-693-1383"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6808 RACCOON CT",
"city": "MELBOURNE",
"state": "FL",
"postal_code": "329406869",
"telephone_number": "321-693-1383"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHIPLEY",
"first_name": "THOMAS",
"name_prefix": "Mr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-06-08",
"last_updated": "2015-06-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "FL",
"license": "IMH8119",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Melbourne, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.