Active NPI
Jenna Cornwell
- Mental Health Counselor
- Saint Clair Shores, MI
National Provider Identifier
1174498521
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 6451024641
- Practice address
- 29750 Harper Ave
Saint Clair Shores, MI 48082-2607 - Phone
- (586) 777-3200
- Fax
- (586) 777-7855
- NPI assigned
- Oct 7, 2025
- 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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 6451024641 | MI | Primary |
Addresses
Primary practice location
29750 Harper Ave
Saint Clair Shores, MI 48082-2607
Mailing address
29750 Harper Ave
Saint Clair Shores, MI 48082-2607
Phone (586) 777-3200
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6451024641 | MI | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1759795200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1759795200000",
"number": "1174498521",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "29750 HARPER AVE",
"city": "SAINT CLAIR SHORES",
"state": "MI",
"postal_code": "480822607",
"telephone_number": "586-777-3200",
"fax_number": "586-777-7855"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "29750 HARPER AVE",
"city": "SAINT CLAIR SHORES",
"state": "MI",
"postal_code": "480822607",
"telephone_number": "586-777-3200",
"fax_number": "586-777-7855"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CORNWELL",
"first_name": "JENNA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-10-07",
"last_updated": "2025-10-07",
"certification_date": "2025-10-07",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "MI",
"license": "6451024641",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Clair Shores, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.