Active NPI
Shelby Dietze
- Professional Counselor
- Coudersport, PA
National Provider Identifier
1912756842
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- PCF017139
- Practice address
- 1 N Main St FL 3
Coudersport, PA 16915-1754 - Phone
- (814) 274-8651
- NPI assigned
- May 14, 2024
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | PC017139 | PA | |
| Professional Counselor | 101YP2500X | PCF017139 | PA | Primary |
Addresses
Primary practice location
1 N Main St FL 3
Coudersport, PA 16915-1754
Mailing address
43 Servidea Dr
Ridgway, PA 15853-6333
Phone (814) 776-2145
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PCF017139 | PA | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1715644800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1715644800000",
"number": "1912756842",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "43 SERVIDEA DR",
"city": "RIDGWAY",
"state": "PA",
"postal_code": "158536333",
"telephone_number": "814-776-2145"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 N MAIN ST FL 3",
"city": "COUDERSPORT",
"state": "PA",
"postal_code": "169151754",
"telephone_number": "814-274-8651"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DIETZE",
"first_name": "SHELBY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-05-14",
"last_updated": "2024-05-14",
"certification_date": "2024-05-14",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "PA",
"license": "PC017139",
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "PA",
"license": "PCF017139",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Coudersport, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.