Shelby M Wynn, ATR, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

0701010054 Issued in VA

Practice address

1942 Fairhope Rd NW
Roanoke, VA 24017-1708

Phone

(540) 815-3644

NPI assigned

Feb 5, 2020

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1580860800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1605571200000",
    "number": "1881226173",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1942 FAIRHOPE RD NW",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240171708",
            "telephone_number": "540-815-3644"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1942 FAIRHOPE RD NW",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240171708",
            "telephone_number": "540-815-3644"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WYNN",
        "first_name": "SHELBY",
        "middle_name": "M",
        "name_prefix": "Miss",
        "credential": "ATR, LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-02-05",
        "last_updated": "2020-11-17",
        "certification_date": "2020-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "VA",
            "license": "0704007013",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "VA",
            "license": "0701010054",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• David A Wyatt, MD
• Kristin Marie Wyatt, PA-C
• Leslie Hutchison Wyatt, ACNP-BC
• Emily H Wycoff, M.ED.,CCC-SLP
• Chelsey Wylder
• Xpress Medical
• Natalie Diane Yacenda, MA, BCBA, LBA
• Sheetal Yadav
• Hayley Maureen Yaga
• Ali M Yahya, MD

• Professional Counselor in Roanoke, VA
• Providers in Roanoke, VA by specialty
• Professional Counselor in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2020; 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.