SHANA MICKENHAM (LPC, CDCS, BHP) – Mental Health Counselor, NPI 1972089738
Mental Health Counselor
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
230 MENTAL HEALTH COUNSELOR in AK
Provider Addresses for SHANA MICKENHAM (LPC, CDCS, BHP)
206 W Rockwell Ave
Soldotna, AK 996697439
Phone: (907) 335-7500
Type: Location
MILE 111.5 RICHARDSON HWY
GLENNALLEN, AK 99588
Phone: (907) 822-5241
Type: Location
Copper Center, Unorganized Borough, Alaska, United States
COPPER CENTER, AK 995730118
Phone:
Type: Mailing
PO BOX 988
KENAI, AK 99611
Phone:
Type: Mailing
508 UPLAND ST
KENAI, AK 996118026
Phone: (907) 335-7500
Type: Location
PO BOX 84101
SEATTLE, WA 981245401
Phone: (907) 335-7500
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2024-05-14
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20240514001286 | I | Mental Health Counselor | AK | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 99669)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Nurse Practitioner | OK | |
| Marriage And Family Therapist | AK | |
| Family Practice | AK | |
| Internal Medicine | TN | |
| Family Practice | AK | |
| Physical Therapist In Private Practice | AK | |
| Clinical Social Worker | AK | |
| O P T O M E T R Y | CA | |
| Physical Therapist In Private Practice | ME | |
| Physical Therapist In Private Practice | AK |
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