Active NPI
Mikki Shenkenberg, MS, TLLP
- Clinical Psychologist
- Troy, MI
National Provider Identifier
1811348782
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 6301016684
- Practice address
- 1777 Axtell Dr
Suite 100
Troy, MI 48084-4404 - Phone
- (248) 613-5573
- NPI assigned
- Jun 22, 2016
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 6301016684 | MI | Primary |
Addresses
Primary practice location
1777 Axtell Dr
Suite 100
Troy, MI 48084-4404
Mailing address
2900 Union Lake Rd
Commerce Township, MI 48382-3500
Phone (248) 613-5377
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
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6301016684 | MI | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mindful Psychology and Wellness, LLC | Clinical | 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
- Commerce Township, MI
- NPI 1932648102
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1466553600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1468281600000",
"number": "1811348782",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2900 UNION LAKE RD",
"city": "COMMERCE TOWNSHIP",
"state": "MI",
"postal_code": "483823500",
"telephone_number": "248-613-5377"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1777 AXTELL DR",
"address_2": "SUITE 100",
"city": "TROY",
"state": "MI",
"postal_code": "480844404",
"telephone_number": "248-613-5573"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHENKENBERG",
"first_name": "MIKKI",
"name_prefix": "Ms.",
"credential": "MS, TLLP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-06-22",
"last_updated": "2016-07-12",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MI",
"license": "6301016684",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Troy, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.