Individual
SHANA MICKENHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC, CDCS, BHP
Contact information
Practice address
508 UPLAND ST, KENAI, AK 99611-8026
(907) 335-7500
Mailing address
PO BOX 84101, SEATTLE, WA 98124-5401
(907) 335-7500
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1716463
—
AK
05
—
1757656
—
AK
Enumeration date
07/16/2018
Last updated
04/13/2026
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