Active NPI
Shana D Mitzel Nicholas, PSY D
- Clinical Psychologist
- Wheaton, IL
National Provider Identifier
1174633192
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 071006921
- Practice address
- 300 E Roosevelt Rd
Suite 105
Wheaton, IL 60187-1908 - Phone
- (847) 732-1704
- NPI assigned
- Aug 30, 2006
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 071006921 | IL | Primary |
Addresses
Primary practice location
300 E Roosevelt Rd
Suite 105
Wheaton, IL 60187-1908
Mailing address
300 E Roosevelt Rd
Suite 105
Wheaton, IL 60187-1908
Phone (847) 732-1704
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01635721 | Other | IL | BCBS |
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 |
|---|---|---|---|
| 071006921 | IL | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Nicholas & Noble Psychological Associates | Clinical | 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.
-
- Clinical Psychologist
- Wheaton, IL
- NPI 1003340027
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156896000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1469750400000",
"number": "1174633192",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "300 E ROOSEVELT RD",
"address_2": "SUITE 105",
"city": "WHEATON",
"state": "IL",
"postal_code": "601871908",
"telephone_number": "847-732-1704"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "300 E ROOSEVELT RD",
"address_2": "SUITE 105",
"city": "WHEATON",
"state": "IL",
"postal_code": "601871908",
"telephone_number": "847-732-1704"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MITZEL NICHOLAS",
"first_name": "SHANA",
"middle_name": "D",
"name_prefix": "Dr.",
"credential": "PSY D",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-30",
"last_updated": "2016-07-29",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "IL",
"license": "071006921",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "01635721",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Wheaton, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.