Active NPI
Nicole Lynn Minnis, MA, LLP
- Clinical Psychologist
- Midland, MI
National Provider Identifier
1063501351
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 6301011787
- Practice address
- 218 Fast Ice Dr
Midland, MI 48642-6167 - Phone
- (989) 631-2320
- Fax
- (989) 631-9214
- NPI assigned
- Oct 12, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 6301011787 | MI | Primary |
Addresses
Primary practice location
218 Fast Ice Dr
Midland, MI 48642-6167
Mailing address
8141 Creston Dr
Freeland, MI 48623-8722
Phone (989) 245-0371
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6301011787 | MI | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160611200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1368576000000",
"number": "1063501351",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8141 CRESTON DR",
"city": "FREELAND",
"state": "MI",
"postal_code": "486238722",
"telephone_number": "989-245-0371"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "218 FAST ICE DR",
"city": "MIDLAND",
"state": "MI",
"postal_code": "486426167",
"telephone_number": "989-631-2320",
"fax_number": "989-631-9214"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MINNIS",
"first_name": "NICOLE",
"middle_name": "LYNN",
"name_prefix": "Mrs.",
"credential": "MA, LLP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-10-12",
"last_updated": "2013-05-15",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MI",
"license": "6301011787",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Midland, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.