Active NPI
Myranda Ellingsen
- Counselor
- Southfield, MI
National Provider Identifier
1104364124
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- Practice address
- 17320 W 12 Mile Rd
Southfield, MI 48076-2100 - Phone
- (586) 806-9726
- NPI assigned
- Feb 9, 2017
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | Primary |
Addresses
Primary practice location
17320 W 12 Mile Rd
Southfield, MI 48076-2100
Mailing address
15117 Chatham St
Detroit, MI 48223-1889
Phone (586) 806-9726
Other practice location 1
2222 W Grand River Ave Ste A
Okemos, MI 48864-1604
Phone (586) 806-9726
Other names 1
- Myranda Jennings
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Myranda Jennings LPC PLLC | Professional | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Professional Counselor
- Okemos, MI
- NPI 1437077138
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1486598400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1787184000000",
"number": "1104364124",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15117 CHATHAM ST",
"city": "DETROIT",
"state": "MI",
"postal_code": "482231889",
"telephone_number": "586-806-9726"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17320 W 12 MILE RD",
"city": "SOUTHFIELD",
"state": "MI",
"postal_code": "480762100",
"telephone_number": "586-806-9726"
}
],
"practiceLocations": [
{
"address_1": "2222 W Grand River Ave Ste A",
"address_purpose": "LOCATION",
"city": "Okemos",
"state": "MI",
"postal_code": "488641604",
"country_code": "US",
"telephone_number": "586-806-9726",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "ELLINGSEN",
"first_name": "MYRANDA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-02-09",
"last_updated": "2026-08-20",
"certification_date": "2026-08-20",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "MYRANDA",
"last_name": "JENNINGS",
"credential": "LPC",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Southfield, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2026; 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.