Active NPI
Krystallynne Shanielle Mikle, PHD, LCSW, MSW, BSW
- Clinical Social Worker
- Porter, TX
National Provider Identifier
1346995818
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 50664
- Practice address
- 21898 FM 1314 Road Suite C PMB 104
Suite C PMB 104
Porter, TX 77365 - Phone
- (832) 556-3079
- NPI assigned
- Feb 14, 2022
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 6
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | 50664 | TX | |
| Mental Health Counselor | 101YM0800X | 50664 | TX | |
| Professional Counselor | 101YP2500X | 50664 | TX | |
| Social Worker | 104100000X | 50664 | TX | |
| Case Management Agency | 251B00000X | |||
| Clinical Social Worker | 1041C0700X | 50664 | TX | Primary |
Addresses
Primary practice location
21898 FM 1314 Road Suite C PMB 104
Suite C PMB 104
Porter, TX 77365
Mailing address
21898 FM 1314 Road
Suite C PMB 104
Porter, TX 77365
Phone (832) 556-3079
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
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 50664 | TX | MD | Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1644796800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1695686400000",
"number": "1346995818",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "21898 FM 1314 ROAD",
"address_2": "SUITE C PMB 104",
"city": "PORTER",
"state": "TX",
"postal_code": "77365",
"telephone_number": "832-556-3079",
"fax_number": "832-556-3079"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "21898 FM 1314 ROAD SUITE C PMB 104",
"address_2": "SUITE C PMB 104",
"city": "PORTER",
"state": "TX",
"postal_code": "77365",
"telephone_number": "832-556-3079"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MIKLE",
"first_name": "KRYSTALLYNNE",
"middle_name": "SHANIELLE",
"name_prefix": "Dr.",
"credential": "PHD, LCSW, MSW, BSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-02-14",
"last_updated": "2023-09-26",
"certification_date": "2023-09-26",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "TX",
"license": "50664",
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "TX",
"license": "50664",
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "TX",
"license": "50664",
"primary": false
},
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "TX",
"license": "50664",
"primary": false
},
{
"code": "251B00000X",
"taxonomy_group": "",
"desc": "Case Management",
"state": null,
"license": null,
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "TX",
"license": "50664",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Porter, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 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.