MEDICARE: MARTHA CAROLINE SHOCKLEY LPC-A

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	R12136	OR
2	101YP2500X	Professional Counselor	98816	TX

General Provider Information

NPI Number	:	1376426783
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTHA CAROLINE SHOCKLEY LPC-A

Provider Business Mailing Address
First Line	:	7545 SE WOODWARD ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97206-1860
Country	:	US
Telephone Number	:	469-955-9082
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 S ZANG BLVD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75208-6600
Country	:	US
Telephone Number	:	405-400-7732
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/31/2025
Last Update Date	:	01/08/2026

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Directions to “ MARTHA CAROLINE SHOCKLEY LPC-A” Practice Location

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