NPIMap

Organization Active NPI

Burdette and Doss Psychological Services LC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Southfield, MI
National Provider Identifier
1073647731
Registry record updated Oct 28, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
License
630534 Issued in MI
Legal business name
BURDETTE AND DOSS PSYCHOLOGICAL SERVICES LC
Practice address
17352 W 12 Mile Rd
Suite 100
Southfield, MI 48076-2119
Phone
(248) 559-0730
Fax
(248) 569-7626
NPI assigned
Mar 15, 2007
Last updated
Oct 28, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 28, 2008

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

Authorized official

Name
Ms. Barbara Ann Elisabeth Tysell
Title
Administrative Director
Phone
(248) 559-0730

Specialties & licenses 13

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X 630534 MI Primary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X 630534 MI
Counselor 101Y00000X NU
Addiction (Substance Use Disorder) Counselor 101YA0400X NU
Mental Health Counselor 101YM0800X NU
Professional Counselor 101YP2500X NU
Psychologist 103T00000X NU
Clinical Psychologist 103TC0700X NU
Clinical Child & Adolescent Psychologist 103TC2200X NU
Psychoanalysis Psychologist 103TP0814X NU
Clinical Social Worker 1041C0700X NU
Marriage & Family Therapist 106H00000X NU
Psychiatry Physician 2084P0800X NU

Addresses

Primary practice location

17352 W 12 Mile Rd
Suite 100
Southfield, MI 48076-2119

Mailing address

17352 W 12 Mile Rd
Suite 100
Southfield, MI 48076-2119
Phone (248) 559-0730

Other identifiers 17

IdentifierTypeStateIssuer
0911921OtherMIBCBS PROVIDER ID MDS
10921OtherMIBCBS MANAGED CARE CODE
38314498OtherMIHAP PROVIDER ID
0910921OtherMIBCBS OF MICHIGAN
7509109210OtherMIVALUEOPTIONS
1316097488OtherMINPPESJAMES A. COWLEY NPI
187925000OtherMIMAGELLAN IDENTIFIER
0912921OtherMIBCBS PROVIDER ID PHDS
P69427OtherMIBLUE CARE NETWORK PIN
20700OtherMIBCBS SUB AB AND MGD CARE
630534OtherMISTATE SUBSTANCE ABUSE LIC
750910921OtherMIBCBS TRADITIONAL CODE
F037350OtherMIWEB DENIS IDENTIFIER
125750OtherMIVALUE OPTIONS PROVIDER ID
26 0 F3 2684 0OtherMINASCO GROUP TRACKING ID
0913921OtherMIBCBS PROVIDER ID MASTERS
7509109210OtherMIBCBS NASCO IDENTIFIER

National Provider Directory

National Provider Directory

Locations

17352 W 12 Mile Rd
Ste 100
Southfield, MI 48076
Phone (248) 559-0730

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1173916800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1225152000000",
    "number": "1073647731",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17352 W 12 MILE RD",
            "address_2": "SUITE 100",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480762119",
            "telephone_number": "248-559-0730",
            "fax_number": "248-569-7626"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17352 W 12 MILE RD",
            "address_2": "SUITE 100",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480762119",
            "telephone_number": "248-559-0730",
            "fax_number": "248-569-7626"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BURDETTE AND DOSS PSYCHOLOGICAL SERVICES LC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-15",
        "last_updated": "2008-10-28",
        "status": "A",
        "authorized_official_last_name": "TYSELL",
        "authorized_official_first_name": "BARBARA ANN",
        "authorized_official_middle_name": "ELISABETH",
        "authorized_official_title_or_position": "ADMINISTRATIVE DIRECTOR",
        "authorized_official_telephone_number": "248-559-0730",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "MI",
            "license": "630534",
            "primary": true
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "MI",
            "license": "630534",
            "primary": false
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "103TP0814X",
            "taxonomy_group": "",
            "desc": "Psychologist, Psychoanalysis",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER ID MDS",
            "identifier": "0911921",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS MANAGED CARE CODE",
            "identifier": "10921",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HAP PROVIDER ID",
            "identifier": "38314498",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF MICHIGAN",
            "identifier": "0910921",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VALUEOPTIONS",
            "identifier": "7509109210",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPPESJAMES A. COWLEY NPI",
            "identifier": "1316097488",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAGELLAN IDENTIFIER",
            "identifier": "187925000",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER ID PHDS",
            "identifier": "0912921",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CARE NETWORK PIN",
            "identifier": "P69427",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS SUB AB AND MGD CARE",
            "identifier": "20700",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE SUBSTANCE ABUSE LIC",
            "identifier": "630534",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS TRADITIONAL CODE",
            "identifier": "750910921",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WEB DENIS IDENTIFIER",
            "identifier": "F037350",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VALUE OPTIONS PROVIDER ID",
            "identifier": "125750",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NASCO GROUP TRACKING ID",
            "identifier": "26 0 F3 2684 0",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER ID MASTERS",
            "identifier": "0913921",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS NASCO IDENTIFIER",
            "identifier": "7509109210",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Southfield, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2008; 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.