Serenity Shield Inc.

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

SERENITY SHIELD INC.

Practice address

2 E Erie St Apt 2712
Chicago, IL 60611-6211

Phone

(708) 657-5043

Fax

(312) 643-1187

NPI assigned

Feb 21, 2021

Organization subpart

No

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

Authorized official

Name

Dr. Derrick James Johnson, PSY.DNPI 1497896674

Title

Vice President

Phone

(708) 657-5043

Specialties & licenses 2

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Derrick James Johnson, PSY.D

  • Professional Counselor
  • Oak Park, IL
  • NPI 1497896674
  NPD Authorized official

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

{
    "created_epoch": "1613865600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1644364800000",
    "number": "1154915122",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 E ERIE ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606112724",
            "telephone_number": "708-657-5043",
            "fax_number": "312-643-1187"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 E ERIE ST APT 2712",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606116211",
            "telephone_number": "708-657-5043",
            "fax_number": "312-643-1187"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SERENITY SHIELD INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-02-21",
        "last_updated": "2022-02-09",
        "certification_date": "2022-02-09",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "DERRICK",
        "authorized_official_middle_name": "JAMES",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "708-657-5043",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Serenity Health & Wellness, LTD
• Serenity Homecare Services of Illinois
• Serenity Hospice LLC
• Serenity Integrative Medicine LTD
• Serenity Path Psychiatry & Wellness PLLC
• Michelle Sergel, M.D.
• Ramsina Sergis, BSN, RN
• Ali Mostafa Serhal, M.D
• Muhamad Serhal, MD
• Peter Serina

• Mental Health Counselor in Chicago, IL
• Providers in Chicago, IL by specialty
• Mental Health Counselor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2022; 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.