Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

SHANNON R WILLIS LCSW 253174
NPI 1417291816
Social Worker - Clinical in Louisville, KY

Active since November 26, 2012
9702 STONESTREET RD, STE. 110, LOUISVILLE, KY 40272(502) 589-8600(502) 589-8771 Get Directions Write a Review

NPPES record last updated: October 6, 2026. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Oct 6, 2026, Sep 30, 2026 (2 updates tracked since 2026).

About Shannon R Willis Lcsw 253174 NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SHANNON R WILLIS LCSW 253174 (NPI 1417291816) is an individual clinical provider in Louisville, Kentucky, licensed in Kentucky (253174) and active in the NPI registry since November 2012.

NPPES Registry Identity

NPI1417291816
Entity TypeIndividualMale
Primary Taxonomy1041C0700X
Provider Legal NameSHANNON R WILLISCredential: LCSW 253174
Location Address9702 STONESTREET RD, STE. 110Louisville, KY 40272-6808
Mailing Address101 W Muhammad Ali BlvdLouisville, KY 40202-1423
Fax(502) 589-8771
Sole ProprietorNo
Enumeration DateNovember 26, 2012
Last NPPES UpdateOctober 6, 20262 updates tracked since enumeration
NPPES CertifiedOctober 6, 2026
✔ NPI 1417291816 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtySocial Worker · ClinicalBehavioral Health & Social Service Providers
Taxonomy Code1041C0700X
License✔ Licensed in KY · 253174
Definition
A social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances.
Also ListedSocial WorkerTaxonomy 104100000X · License 253174 (KY)
9702 STONESTREET RD, Louisville, KY 40272

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Pediatrics
9702 STONESTREET RD, STE 100
LOUISVILLE, KY 40272
Nurse Practitioner (Psychiatric/Mental Health)
9702 STONESTREET RD, STE. 110
LOUISVILLE, KY 40272
Social Worker (Clinical)
9702 STONESTREET RD, STE. 110
LOUISVILLE, KY 40272
Social Worker (Clinical)
9702 STONESTREET RD
LOUISVILLE, KY 40272
Social Worker (Clinical)
9702 STONESTREET RD, #110
LOUISVILLE, KY 40272
Counselor (Addiction (Substance Use Disorder))
9702 STONESTREET RD
LOUISVILLE, KY 40272
Counselor
9702 STONESTREET RD, STE. 110
LOUISVILLE, KY 40272
Marriage & Family Therapist
9702 STONESTREET RD
LOUISVILLE, KY 40272

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Shannon Willis's NPI number?

The NPI number for Shannon Willis is 1417291816. It was assigned to this individual provider in the NPPES registry on November 26, 2012.

Where is Shannon Willis located?

Shannon Willis practices at 9702 Stonestreet Rd Ste. 110, Louisville, KY 40272. The listed phone number is (502) 589-8600.

What is Shannon Willis's specialty?

The primary specialty registered for this NPI is Social Worker, specializing in Clinical, with taxonomy code 1041C0700X.

When was this NPI record last updated?

The NPPES record for Shannon Willis was last updated on October 6, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 days ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.