Denequa Diane Mixon, MS, TLLP

Primary specialty

PsychologistTaxonomy code 103T00000X

License

6362009487 Issued in MI

Practice address

707 W. Milwaukee
Detroit, MI 48202

Phone

(313) 833-2500

NPI assigned

Oct 10, 2011

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1318204800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1764633600000",
    "number": "1235413121",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15001 KERCHEVAL AVE # 397",
            "city": "GROSSE POINTE PARK",
            "state": "MI",
            "postal_code": "482301361",
            "telephone_number": "586-229-4024"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "707 W. MILWAUKEE",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "48202",
            "telephone_number": "313-833-2500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIXON",
        "first_name": "DENEQUA",
        "middle_name": "DIANE",
        "name_prefix": "Ms.",
        "credential": "MS, TLLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-10-10",
        "last_updated": "2025-12-02",
        "certification_date": "2025-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MI",
            "license": "1235413121",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MI",
            "license": "6362009487",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Aayush Mittal, MD
• Saachi Mittal, MD
• Vashudevan Mittal, MD
• Krishna Latha Mittapelli, PT
• Kimberly Mix, PA-C
• Myra Elaine Mixon
• Shannon Mixon
• Shania Maria Mize
• Sebastian Mizgala
• Takeshi Mizobuchi

• Psychologist in Detroit, MI
• Providers in Detroit, MI by specialty
• Psychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 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.

Verify at the official NPI Registry.