Individual provider Active NPI

Kris Shehu, TLLP

  • Clinical Psychologist
  • Detroit, MI
National Provider Identifier
1407404262
Registry record updated Oct 17, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
6301018060 Issued in MI
Practice address
1300 Broadway St
Suite 400
Detroit, MI 48226-4822
Phone
(313) 312-5051
NPI assigned
Aug 26, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 6301018060 MI Primary

Addresses

Primary practice location

1300 Broadway St
Suite 400
Detroit, MI 48226-4822

Mailing address

1300 Broadway St
Suite 400
Detroit, MI 48226
Phone (313) 312-5051

Other practice location 1

42500 Hayes Rd Ste 500
Clinton Township, MI 48038-6768
Phone (586) 828-1221

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

LicenseStateTypeSpecialty
6301018060MIMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Arbor Wellness Center, PLLC PastSince Sep 1, 2019 Accepting new patients
Thrive Behavioral Health Clinical Past Accepting new patients

Interoperability endpoints

  • FHIR API: https://app.meldrx.com/api/fhir/pimsy-thrive

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1566777600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1571270400000",
    "number": "1407404262",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1300 BROADWAY ST",
            "address_2": "SUITE 400",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "48226",
            "telephone_number": "313-312-5051"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 BROADWAY ST",
            "address_2": "SUITE 400",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482264822",
            "telephone_number": "313-312-5051"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "42500 Hayes Rd Ste 500",
            "address_purpose": "LOCATION",
            "city": "Clinton Township",
            "state": "MI",
            "postal_code": "480386768",
            "country_code": "US",
            "telephone_number": "586-828-1221",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHEHU",
        "first_name": "KRIS",
        "credential": "TLLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-08-26",
        "last_updated": "2019-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MI",
            "license": "6301018060",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Detroit, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2019; 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.