Active NPI
Nicole Henriksen
- Psychologist
- Southfield, MI
National Provider Identifier
1255675005
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 6301014788
- Practice address
- 29120 Franklin Rd
Southfield, MI 48034-1105 - Phone
- (248) 351-7671
- NPI assigned
- Nov 17, 2012
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | 1-11-9594 | MI | |
| Psychologist | 103T00000X | 6301014788 | MI | Primary |
Addresses
Primary practice location
29120 Franklin Rd
Southfield, MI 48034-1105
Mailing address
29120 Franklin Rd
Southfield, MI 48034-1105
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)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6301014788 | MI | MD | Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Integrated Behavioral Health Psychological Services, PLLC | 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
- Kalamazoo, MI
- NPI 1295073393
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1353110400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1681430400000",
"number": "1255675005",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "29120 FRANKLIN RD",
"city": "SOUTHFIELD",
"state": "MI",
"postal_code": "480341105"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "29120 FRANKLIN RD",
"city": "SOUTHFIELD",
"state": "MI",
"postal_code": "480341105",
"telephone_number": "248-351-7671"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HENRIKSEN",
"first_name": "NICOLE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-11-17",
"last_updated": "2023-04-14",
"certification_date": "2023-04-14",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "MI",
"license": "1-11-9594",
"primary": false
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MI",
"license": "6301014788",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Southfield, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.