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GREAT MINDS OF MICHIGAN PLLC NPI 1609173921


NPI Information

NPI: 1609173921
Provider Name: GREAT MINDS OF MICHIGAN PLLC
Classification: Clinical Neuropsychologist - 103G00000X
Entity Type: Organization
Address:
200 DIVERSION ST
SUITE 150
ROCHESTER HILLS, MI
ZIP 48307
Phone: (586) 913-1038
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GREAT MINDS OF MICHIGAN PLLC is a clinical neuropsychologist in Rochester Hills, MI. The provider is a clinical psychologist who applies principles of assessment and intervention based upon the scientific study of human behavior as it relates to normal and abnormal functioning of the central nervous system. The specialty is dedicated to enhancing the understanding of brain-behavior relationships and the application of such knowledge to human problems. GREAT MINDS OF MICHIGAN PLLC NPI is 1609173921. The provider is registered as an organization entity type and is a multiple single specialty group.

The provider's business location address is:

200 DIVERSION ST
SUITE 150
ROCHESTER HILLS, MI
ZIP 48307-267
Phone: (586) 913-1038
Fax: (586) 773-3355

The provider's authorized official is Janet S Reed .
The authorized official title is Member, Director and has the following contact phone number (586) 913-1038.

The enumeration date for this NPI number is 2/23/2011 and was last updated on 2/23/2011.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1103TC0700XPsychologistClinical6301012828MICHIGANNo
2103TC2200XPsychologistClinical Child & Adolescent6301012828MICHIGANNo
3103TM1800XPsychologistIntellectual and Developmental Disabilities6301012828MICHIGANNo
4103G00000XClinical Neuropsychologist6301012828MICHIGANYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1P42853MEDICARE PINMICHIGAN
2JR012828OTHERMICHIGANCOMMERCIAL-COMMERCIAL
3JR012828OTHERMICHIGANCHAMPUS-CHAMPUS
4PHD888810MEDICAIDMICHIGAN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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