Active NPI
Shannon Renee Willey, M.ED
- Mental Health Counselor
- Lexington Park, MD
National Provider Identifier
1891076337
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- LGP11287
- Practice address
- 21270 Mayfaire LN Unit 301
Lexington Park, MD 20653-5394 - Phone
- (410) 463-1655
- NPI assigned
- Aug 29, 2011
- Sex
- Female
- Sole proprietor
- No
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 | LGP11287 | MD | Primary |
Addresses
Primary practice location
21270 Mayfaire LN Unit 301
Lexington Park, MD 20653-5394
Mailing address
21270 Mayfaire LN Unit 301
Lexington Park, MD 20653-5394
Phone (410) 463-1655
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 Education
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LGP11287 | MD | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1314576000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1618272000000",
"number": "1891076337",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "21270 MAYFAIRE LN UNIT 301",
"city": "LEXINGTON PARK",
"state": "MD",
"postal_code": "206535394",
"telephone_number": "410-463-1655"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "21270 MAYFAIRE LN UNIT 301",
"city": "LEXINGTON PARK",
"state": "MD",
"postal_code": "206535394",
"telephone_number": "410-463-1655"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLEY",
"first_name": "SHANNON",
"middle_name": "RENEE",
"credential": "M.ED",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-08-29",
"last_updated": "2021-04-13",
"certification_date": "2021-04-13",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "MD",
"license": "LGP11287",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lexington Park, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 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.