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SHOCKIE M DERSNO LPC
NPI 1154961464
Counselor - Mental Health in Phoenix, AZ

Active since January 14, 2020PECOS Enrolled
1840 N 95TH AVE STE 146, PHOENIX, AZ 85037(404) 953-2501 Get Directions Write a Review

NPPES record last updated: July 1, 2025. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Jul 1, 2025, Jan 28, 2020, Jan 14, 2020 (3 updates tracked since 2020).

About Shockie M Dersno Lpc NPPES

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

SHOCKIE M DERSNO LPC (NPI 1154961464) is an individual mental health provider in Phoenix, Arizona, licensed in Arizona (LPC-18672) and active in the NPI registry since January 2020. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1154961464
Entity TypeIndividualFemale
Primary Taxonomy101YM0800X
Provider Legal NameSHOCKIE M DERSNOCredential: LPC
Location Address1840 N 95TH AVE STE 146Phoenix, AZ 85037-4446
Mailing Address1840 N 95th Ave Ste 146Phoenix, AZ 85037-4446 · (623) 234-9828 · Fax (623) 234-9815
Phone(404) 953-2501
Sole ProprietorNo
Enumeration DateJanuary 14, 2020
Last NPPES UpdateJuly 1, 20253 updates tracked since enumeration
NPPES CertifiedJuly 1, 2025
✔ NPI 1154961464 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyCounselor · Mental HealthBehavioral Health & Social Service Providers
Taxonomy Code101YM0800X
License✔ Licensed in AZ · LPC-18672
Also ListedCounselor · ProfessionalTaxonomy 101YP2500X · License 18672 (AZ)
1840 N 95TH AVE STE 146, Phoenix, AZ 85037
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Antidote Health Plan of Arizona, Inc., Blue Cross Blue Shield of Arizona, Cigna HealthCare of Arizona, Inc and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Shockie M Dersno Lpc 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.

Medicare Billing Reassignment

Medicare enrollment records show Shockie Dersno reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Neighborhood Outreach Access To Health
10 mi
Federally Qualified Health Center (FQHC)
11851 N 51ST AVE STE B110
Glendale, AZ 85304
  • Reassigned Medicare billing, Arizona enrollment
  • 119 clinicians in this Medicare group
NPI 1629515218 (480) 882-4545

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Other Providers at the Same Location NPPES 5

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

MR. TROY MICHAEL RINGLE MC, LPC
Counselor (Mental Health)
1840 N 95TH AVE STE 146
PHOENIX, AZ 85037
Maricopa County (623) 234-9811
MS. PATRICIA CONLEY GLINSKI MA, LISAC, CCS
Counselor
1840 N 95TH AVE STE 146
PHOENIX, AZ 85037
Maricopa County (623) 234-9811
MAGDALENA LOPEZ
Counselor (Professional)
1840 N 95TH AVE STE 146
PHOENIX, AZ 85037
Maricopa County (623) 234-9811
SHARRON HIER PMHNP-BC
Nurse Practitioner (Psychiatric/Mental Health)
1840 N 95TH AVE STE 146
PHOENIX, AZ 85037
Maricopa County (623) 234-9811
RANDALL HARSHA LPC
Counselor (Mental Health)
1840 N 95TH AVE STE 146
PHOENIX, AZ 85037
Maricopa County (623) 234-9811

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Shockie Dersno's NPI number?

The NPI number for Shockie Dersno is 1154961464. It was assigned to this individual provider in the NPPES registry on January 14, 2020.

Where is Shockie Dersno located?

Shockie Dersno practices at 1840 N 95th Ave Ste 146, Phoenix, AZ 85037. The listed phone number is (404) 953-2501.

What is Shockie Dersno's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Mental Health, with taxonomy code 101YM0800X.

Is Shockie Dersno enrolled in Medicare?

Yes. Shockie Dersno is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Shockie Dersno's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Shockie Dersno reassigns Medicare benefits to Neighborhood Outreach Access To Health (Glendale, AZ). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Shockie Dersno's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Shockie Dersno accept?

Health plans from Antidote Health Plan of Arizona, Inc., Blue Cross Blue Shield of Arizona, Cigna HealthCare of Arizona, Inc, Imperial Insurance Companies, Inc. and Oscar Health Plan, Inc. and 1 other insurer list Shockie Dersno as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Shockie Dersno was last updated on July 1, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 months 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.