Edward J. Shea, MA, LAC

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

1114 Issued in ND

Practice address

200 Pulver Hall
Dickinson, ND 58601-4878

Phone

(701) 227-7580

Fax

(701) 227-7575

NPI assigned

Jul 25, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Badlands Behavioral Health Clinic

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Dickinson, ND
  • NPI 1124072525
  NPD (past)

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

{
    "created_epoch": "1153785600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1891718672",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 PULVER HALL",
            "city": "DICKINSON",
            "state": "ND",
            "postal_code": "586014878",
            "telephone_number": "701-227-7580",
            "fax_number": "701-227-7575"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 PULVER HALL",
            "city": "DICKINSON",
            "state": "ND",
            "postal_code": "586014878",
            "telephone_number": "701-227-7580",
            "fax_number": "701-227-7575"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHEA",
        "first_name": "EDWARD",
        "middle_name": "J.",
        "name_prefix": "Mr.",
        "credential": "MA, LAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-25",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "ND",
            "license": "1114",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "54523",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PIN",
            "identifier": "09113",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Selle Family Dental, PC
• Brent Jonathon Selle, DDS
• Krysta Sellers, D.M.D., M.S.
• Sherman Severson, MD
• Christopher Sharp
• Kamille S Sherman, MD
• Nathaniel Dean Shilman, O.D.
• Christina Jean Shockley, FNP-C, PMHNP-BC
• Jessie Nicole Shypkowski, M.S.
• Allen L Siegler Jr., LICSW, BCD

• Addiction (Substance Use Disorder) Counselor in Dickinson, ND
• Providers in Dickinson, ND by specialty
• Addiction (Substance Use Disorder) Counselor in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.