Individual provider Active NPI

Shenna Marie Payne, MA, LMFT

  • Marriage & Family Therapist
  • New Brighton, MN
National Provider Identifier
1972992675
Registry record updated Jan 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
3508 Issued in MN
Practice address
1900 Silver Lake Rd NW
New Brighton, MN 55112-1786
Phone
(651) 628-9566
Fax
(651) 628-0411
NPI assigned
Jan 19, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 17, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X 3508 MN Primary
Addiction (Substance Use Disorder) Counselor 101YA0400X 303501 MN

Addresses

Primary practice location

1900 Silver Lake Rd NW
New Brighton, MN 55112-1786

Mailing address

1900 Silver Lake Rd NW Ste 110
New Brighton, MN 55112-1789
Phone (651) 628-9566

Other names 1

  • Shenna Manteuffel Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240214000478 MN Practitioner - Marriage and Family Therapist 3274977616 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Marriage and Family Therapist
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Nystrom and Associates LTDGroup PAC ID 6406752492, 590 clinicians

Practice addresses (Care Compare)

1900 Silver Lake Rd NW
Suite 110
New Brighton, MN 55112-1789
Phone (651) 628-9566

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Arts

State licenses

LicenseStateTypeSpecialty
303501MNMDAddiction (Substance Use Disorder) Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Nystrom & Associates, LTD Marriage & Family Therapist CurrentSince Jan 1, 2024 Accepting new patients

Locations

1900 Silver Lake Rd NW
Saint Paul, MN 55112
Phone (651) 379-1704

1900 Silver Lake Rd NW
Ste 110
Saint Paul, MN 55112
Phone (651) 379-1718

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.

NPI Registry JSON

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

{
    "created_epoch": "1421625600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737072000000",
    "number": "1972992675",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 SILVER LAKE RD NW STE 110",
            "city": "NEW BRIGHTON",
            "state": "MN",
            "postal_code": "551121789",
            "telephone_number": "651-628-9566",
            "fax_number": "651-628-0411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1900 SILVER LAKE RD NW",
            "city": "NEW BRIGHTON",
            "state": "MN",
            "postal_code": "551121786",
            "telephone_number": "651-628-9566",
            "fax_number": "651-628-0411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAYNE",
        "first_name": "SHENNA",
        "middle_name": "MARIE",
        "credential": "MA, LMFT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-01-19",
        "last_updated": "2025-01-17",
        "certification_date": "2025-01-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "MN",
            "license": "3508",
            "primary": true
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MN",
            "license": "303501",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHENNA",
            "last_name": "MANTEUFFEL",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in New Brighton, MN

Sources for this page

Verify at the official NPI Registry.