Kristen M Shealy, EDM; CAS; LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

5762 Issued in SC

Practice address

1012 Anna Knapp Ext
Mt Pleasant, SC 29464-5400

Phone

(843) 800-0626

Fax

(843) 884-0061

NPI assigned

May 13, 2009

Sex

Female

Sole proprietor

No

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

Specialties & licenses 5

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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

• SLM Group

  • Psychiatry Physician
  • Mount Pleasant, SC
  • NPI 1467270538
  NPD (past)

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

{
    "created_epoch": "1242172800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1522108800000",
    "number": "1891929212",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1012 ANNA KNAPP EXT",
            "city": "MT PLEASANT",
            "state": "SC",
            "postal_code": "294645400",
            "telephone_number": "843-800-0626",
            "fax_number": "843-884-0061"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1012 ANNA KNAPP EXT",
            "city": "MT PLEASANT",
            "state": "SC",
            "postal_code": "294645400",
            "telephone_number": "843-800-0626",
            "fax_number": "843-884-0061"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "171 Ashley Ave",
            "address_purpose": "LOCATION",
            "city": "Charleston",
            "state": "SC",
            "postal_code": "294258908",
            "country_code": "US",
            "telephone_number": "843-792-1414",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHEALY",
        "first_name": "KRISTEN",
        "middle_name": "M",
        "credential": "EDM; CAS; LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-05-13",
        "last_updated": "2018-03-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "SC",
            "license": "5762",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "SC",
            "license": "5762",
            "primary": true
        },
        {
            "code": "1041S0200X",
            "taxonomy_group": "",
            "desc": "Social Worker, School",
            "state": "SC",
            "license": "5762",
            "primary": false
        },
        {
            "code": "1041S0200X",
            "taxonomy_group": "",
            "desc": "Social Worker, School",
            "state": "MA",
            "license": "419253",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "59454",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nicholas C. Shaheen, MD
• Briana Shakir-Lesesne
• Ritu Sharma, RPT
• Elizabeth D Sharpe, M.D.
• Ellen Shaw, M.ED. ,LPC
• Ralph McKeetha Shealy, M.D.
• Lorie Jane Shearon-Hanna, RN,CDE
• Rhiannon Shelbourne, RD, LD
• Sheldon C. Levin PH.D., LLC
• Shelley Birnie Physical Therapy, LLC

• Professional Counselor in Mount Pleasant, SC
• Providers in Mount Pleasant, SC by specialty
• Professional Counselor in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2018; 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.