Addis Lee Shepherd, THERAPIST

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

275079 Issued in KY

Practice address

The Commitment House
115 Parkway Drive
Elizabethtown, KY 42701-7827

Phone

(270) 900-0373

NPI assigned

Sep 11, 2018

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 1

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 and National Provider Directory roles.

• The Commitment House LLC

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Clarksville, IN
  • NPI 1801296314
  NPD (past)

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

{
    "created_epoch": "1536624000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704672000000",
    "number": "1942783436",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "902 WINCHESTER BLVD",
            "city": "ELIZABETHTOWN",
            "state": "KY",
            "postal_code": "427019167",
            "telephone_number": "270-325-1027",
            "fax_number": "270-765-2557"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "THE COMMITMENT HOUSE",
            "address_2": "115 PARKWAY DRIVE",
            "city": "ELIZABETHTOWN",
            "state": "KY",
            "postal_code": "427017827",
            "telephone_number": "270-900-0373"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHEPHERD",
        "first_name": "ADDIS",
        "middle_name": "LEE",
        "name_prefix": "Mr.",
        "credential": "THERAPIST",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-09-11",
        "last_updated": "2024-01-08",
        "certification_date": "2023-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "KY",
            "license": "275079",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "$$$$$$$$$",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dawn M Shelby, MSN, ARNP
• Adam Wayne Shelley
• Elizabeth Anne Shelton, APRN
• Sara Shelton
• Trina Shelton
• Jessica A Shepherd
• Savannah Dean Shepherd
• Marianne Mills Sheroan, D.M.D, M.S.
• Rhonda Shircliff, ARNP
• Dennis Gerald Shoff, MD

• Mental Health Counselor in Elizabethtown, KY
• Providers in Elizabethtown, KY by specialty
• Mental Health Counselor in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2024; 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.