Active NPI
Jackie Lynn Shamsollahi, MS, LPC
- Counselor
- Durant, OK
National Provider Identifier
1831649276
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- 1853
- Practice address
- 324 N Washington Ave
Durant, OK 74701-3642 - Phone
- (580) 931-3008
- NPI assigned
- Oct 10, 2016
- 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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 1853 | OK | |
| Counselor | 101Y00000X | 1853 | Primary |
Addresses
Primary practice location
324 N Washington Ave
Durant, OK 74701-3642
Mailing address
401 Northridge Dr
Durant, OK 74701-2561
Phone (405) 880-7301
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1853 | OK | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1476057600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1724198400000",
"number": "1831649276",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "401 NORTHRIDGE DR",
"city": "DURANT",
"state": "OK",
"postal_code": "747012561",
"telephone_number": "405-880-7301",
"fax_number": "580-924-0379"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "324 N WASHINGTON AVE",
"city": "DURANT",
"state": "OK",
"postal_code": "747013642",
"telephone_number": "580-931-3008"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHAMSOLLAHI",
"first_name": "JACKIE",
"middle_name": "LYNN",
"name_prefix": "Ms.",
"credential": "MS, LPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-10-10",
"last_updated": "2024-08-21",
"certification_date": "2024-08-21",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "OK",
"license": "1853",
"primary": false
},
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": null,
"license": "1853",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Durant, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 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.