Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

MYRANDA ELLINGSEN
NPI 1104364124
Counselor in Southfield, MI

Q: What is Myranda Ellingsen's NPI number?

The NPI number for Myranda Ellingsen is 1104364124. It was assigned to this individual provider in the NPPES registry on February 9, 2017. The provider is also known as Myranda Jennings Lpc.

Q: What is Myranda Ellingsen's specialty?

The primary specialty registered for this NPI is Counselor with taxonomy code 101Y00000X.

Q: When was this NPI record last updated?

The NPPES record for Myranda Ellingsen was last updated on August 20, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 days ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since February 09, 2017PECOS Enrolled

17320 W 12 MILE RD, SOUTHFIELD, MI 48076(586) 806-9726 Get Directions Write a Review

NPPES record last updated: August 20, 2026. Verified against the NPPES registry weekly; last sync: August 23, 2026.

Record update history: Aug 20, 2026, Feb 9, 2017 (2 updates tracked since 2017).

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About Myranda Ellingsen NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MYRANDA ELLINGSEN (NPI 1104364124) is an individual counselor in Southfield, Michigan and active in the NPI registry since February 2017. She is enrolled in Medicare PECOS and maintains a secondary practice location in Okemos.

NPPES Registry Identity

NPI1104364124

Entity TypeIndividualFemale

Primary Taxonomy101Y00000X

Provider Legal NameMYRANDA ELLINGSEN

Location Address17320 W 12 MILE RDSouthfield, MI 48076-2100

Mailing Address15117 Chatham StDetroit, MI 48223-1889 · (586) 806-9726

Phone(586) 806-9726

Sole ProprietorNo

Enumeration DateFebruary 9, 2017

Last NPPES UpdateAugust 20, 20262 updates tracked since enumeration

NPPES CertifiedAugust 20, 2026

✔ NPI 1104364124 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselorBehavioral Health & Social Service Providers

Taxonomy Code101Y00000X

Definition

A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master's degree and clinical experience and supervision for licensure or certification.

17320 W 12 MILE RD, Southfield, MI 48076

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Other Names 1

Former Name (1)Myranda Jennings Lpc

Secondary Practice Location 1

Location 12222 W Grand River Ave Ste AOkemos, MI 48864-1604 · Phone (586) 806-9726

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include McLaren Health Plan Community, Priority Health.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Myranda Ellingsen is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer– Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

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