Shannon Marie Waters

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

C6686 Issued in OR

Practice address

2440 Willamette St Ste 201
Eugene, OR 97405-3170

Phone

(541) 321-2278

NPI assigned

Jan 8, 2020

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in OR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1578441600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706140800000",
    "number": "1831739796",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "223 COMMERCIAL ST NE STE 205",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973014078",
            "telephone_number": "503-966-2722"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2440 WILLAMETTE ST STE 201",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "974053170",
            "telephone_number": "541-321-2278"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "223 Commercial St NE Ste 205",
            "address_purpose": "LOCATION",
            "city": "Salem",
            "state": "OR",
            "postal_code": "973014078",
            "country_code": "US",
            "telephone_number": "503-966-2722",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WATERS",
        "first_name": "SHANNON",
        "middle_name": "MARIE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-01-08",
        "last_updated": "2024-01-25",
        "certification_date": "2024-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": "OR",
            "license": "C6686",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500775892",
            "state": "OR"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mindfuljourneycounseling@therapysecure.com",
            "affiliation": "N",
            "endpointDescription": "HIPPA Private Practice email",
            "address_1": "223 Commercial St NE Ste 205",
            "city": "Salem",
            "state": "OR",
            "country_code": "US",
            "postal_code": "973014078",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "credentialing@arisecounselingservice.com",
            "affiliation": "N",
            "endpointDescription": "HIPPA work email",
            "address_1": "2440 Willamette St Ste 201",
            "city": "Eugene",
            "state": "OR",
            "country_code": "US",
            "postal_code": "974053170",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Maya Kathleen Washizu, LAC
• Jennifer Gwen Wassermiller, MSW
• Carrie S Waters, PT
• Kathryn C Waters, DC
• Scott J Waters, LPC
• Judith A. Watkins, M.D.
• Marjorie Lucille Watkins, QMHP
• Susan Watkins
• Tyler Watkins
• Elizabeth Ryann Watson-Stites, PHD

• Professional Counselor in Eugene, OR
• Providers in Eugene, OR by specialty
• Professional Counselor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.