Kelly Grace Shaw, MS, LPC, NCC

Primary specialty

CounselorTaxonomy code 101Y00000X

Practice address

770 E 11TH Ave FL SSB2
Eugene, OR 97401-3746

Phone

(458) 205-7085

Fax

(458) 205-7089

NPI assigned

May 17, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

Practice roles

Locations

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.

• Peacehealth Medical Group

  • Family Medicine Physician
  • Eugene, OR
  • NPI 1447207287

  Counselor

  Medicare reassignment NPD

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

{
    "created_epoch": "1558051200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699920000000",
    "number": "1962068650",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 18",
            "city": "VIDA",
            "state": "OR",
            "postal_code": "974880018",
            "telephone_number": "541-771-1017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "770 E 11TH AVE FL SSB2",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "974013746",
            "telephone_number": "458-205-7085",
            "fax_number": "458-205-7089"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "175 W B St",
            "address_purpose": "LOCATION",
            "city": "Springfield",
            "state": "OR",
            "postal_code": "974774575",
            "country_code": "US",
            "telephone_number": "541-762-1971",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "54771 McKenzie Hwy",
            "address_purpose": "LOCATION",
            "city": "Blue River",
            "state": "OR",
            "postal_code": "974139790",
            "country_code": "US",
            "telephone_number": "541-771-1017",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHAW",
        "first_name": "KELLY",
        "middle_name": "GRACE",
        "credential": "MS, LPC, NCC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-05-17",
        "last_updated": "2023-11-14",
        "certification_date": "2023-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "OR",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cedar Sharpe, LCSW
• John Sharrer, MD
• Morgan Krista Shasteen, NP-C
• Jonathan Shaw, PMHNP
• Kaylin Shaw, COTA/L
• Shawmed, Inc.
• Nathan Shay
• Frank A Sheaffer, DPM
• Anastasya L. Shearer, LPCA, NCC, PELSC
• Lisa Sheeber

• Counselor in Eugene, OR
• Providers in Eugene, OR by specialty
• Counselor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2023; 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.

Verify at the official NPI Registry.