Shana Susanne Mevissen

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

3 Amhurst Ave # 3
Wilton, NY 12831-1834

Phone

(517) 778-5881

NPI assigned

Jan 15, 2020

Last updated

Jan 15, 2020By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1579046400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1579046400000",
    "number": "1245870443",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "713 TROY SCHENECTADY RD STE 224",
            "city": "LATHAM",
            "state": "NY",
            "postal_code": "121102490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3 AMHURST AVE # 3",
            "city": "WILTON",
            "state": "NY",
            "postal_code": "128311834",
            "telephone_number": "517-778-5881"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEVISSEN",
        "first_name": "SHANA",
        "middle_name": "SUSANNE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-01-15",
        "last_updated": "2020-01-15",
        "certification_date": "2020-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Latham",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Latham",
            "address_1": "711 Troy Schenectady Rd Ste 224",
            "city": "Latham",
            "state": "NY",
            "country_code": "US",
            "postal_code": "121102461",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Latham",
            "affiliation": "N",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "Latham",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Latham",
            "address_1": "711 Troy Schenectady Rd Ste 224",
            "city": "Latham",
            "state": "NY",
            "country_code": "US",
            "postal_code": "121102461",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Mental Health Counselor in Wilton, NY
• Providers in Wilton, NY by specialty
• Mental Health Counselor in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2020; 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.