Shockie M Dersno, LPC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

LPC-18672 Issued in AZ

Practice address

1840 N 95TH Ave Ste 146
Phoenix, AZ 85037-4446

Phone

(404) 953-2501

NPI assigned

Jan 14, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

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

State licenses

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.

• Neighborhood Outreach Access to Health

  • Family Medicine Physician
  • Scottsdale, AZ
  • NPI 1942518550

  Mental Health

  Medicare reassignment NPD
• Neighborhood Outreach Access to Health

  • Federally Qualified Health Center (FQHC)
  • Glendale, AZ
  • NPI 1326731555
  NPD

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

{
    "created_epoch": "1578960000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1751328000000",
    "number": "1154961464",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1840 N 95TH AVE STE 146",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850374446",
            "telephone_number": "623-234-9828",
            "fax_number": "623-234-9815"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1840 N 95TH AVE STE 146",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850374446",
            "telephone_number": "404-953-2501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERSNO",
        "first_name": "SHOCKIE",
        "middle_name": "M",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-01-14",
        "last_updated": "2025-07-01",
        "certification_date": "2025-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "AZ",
            "license": "18672",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "AZ",
            "license": "LPC-18672",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brenda Joyce Derrick, LPN
• Cheri Diane Dersam, M.D.
• Michael D Dersam, MD
• Anne Merrylees Dersch, MD
• Michael H Dershowitz, DPM
• Jenna Derubeis, OD
• Ina Dervishi, MD
• Juniper Dery-Chaffin, PA-C
• Anish Kumar Desai, MD
• Dev M. Desai, M.D.

• Mental Health Counselor in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Mental Health Counselor in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2025; 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.