Midwest Michigan Psychological Associates, PLLC

Primary specialty

PsychologistTaxonomy code 103T00000X

License

6301013463 Issued in MI

Legal business name

MIDWEST MICHIGAN PSYCHOLOGICAL ASSOCIATES, PLLC

Practice address

811 Sunnyside Dr
Suite I
Cadillac, MI 49601-7002

Phone

(231) 878-3059

Fax

(866) 217-1182

NPI assigned

Jul 16, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Craig Allen Derror, PHD

Title

Executive Director

Phone

(231) 878-3059

Specialties & licenses 2

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1184544000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1184544000000",
    "number": "1033318340",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "811 SUNNYSIDE DR",
            "address_2": "SUITE I",
            "city": "CADILLAC",
            "state": "MI",
            "postal_code": "496017002",
            "telephone_number": "231-878-3059",
            "fax_number": "866-217-1182"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "811 SUNNYSIDE DR",
            "address_2": "SUITE I",
            "city": "CADILLAC",
            "state": "MI",
            "postal_code": "496017002",
            "telephone_number": "231-878-3059",
            "fax_number": "866-217-1182"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDWEST MICHIGAN PSYCHOLOGICAL ASSOCIATES, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-16",
        "last_updated": "2007-07-16",
        "status": "A",
        "authorized_official_last_name": "DERROR",
        "authorized_official_first_name": "CRAIG",
        "authorized_official_middle_name": "ALLEN",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "231-878-3059",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": "MI",
            "license": "6401004326",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": "MI",
            "license": "6301013463",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.