Individual provider Active NPI

Daniel Charles Stettner LP, PH.D.

  • Clinical Psychologist
  • Bingham Farms, MI
National Provider Identifier
1093821597
Registry record updated Aug 5, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
6301003996 Issued in MI
Practice address
30150 Telegraph Rd Ste 245
Bingham Farms, MI 48025-4521
Phone
(248) 693-1916
Fax
(248) 605-3525
NPI assigned
Aug 21, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 5, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 6301003996 MI Primary

Addresses

Primary practice location

30150 Telegraph Rd Ste 245
Bingham Farms, MI 48025-4521

Mailing address

30150 Telegraph Rd Ste 245
Bingham Farms, MI 48025-4521
Phone (800) 693-1916

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110201000121 MI Practitioner - Clinical Psychologist 6608055041 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1976
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Richard Kneip PHD PCGroup PAC ID 4880768415, 243 clinicians

Practice addresses (Care Compare)

6548 Town Ctr Dr
Suite D
Clarkston, MI 48346-4823
Phone (800) 693-1916

89 W S Blvd
200 Great Lakes Psychology Group
Troy, MI 48085-1612
Phone (800) 693-1916

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
6301003996MIMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Richard Kneip, PH.D., P.C. CurrentSince Apr 3, 2019 Accepting new patients

Locations

30150 Telegraph Rd
Ste 245
Bingham Farms, MI 48025
Phone (248) 238-1824

6548 Town Center Dr
Ste D
Clarkston, MI 48346
Phone (248) 212-8739

89 W South Blvd
Ste 200
Troy, MI 48085
Phone (248) 813-8840

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1156118400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659657600000",
    "number": "1093821597",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30150 TELEGRAPH RD STE 245",
            "city": "BINGHAM FARMS",
            "state": "MI",
            "postal_code": "480254521",
            "telephone_number": "800-693-1916",
            "fax_number": "248-605-3525"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30150 TELEGRAPH RD STE 245",
            "city": "BINGHAM FARMS",
            "state": "MI",
            "postal_code": "480254521",
            "telephone_number": "248-693-1916",
            "fax_number": "248-605-3525"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STETTNER LP",
        "first_name": "DANIEL",
        "middle_name": "CHARLES",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-21",
        "last_updated": "2022-08-05",
        "certification_date": "2022-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MI",
            "license": "6301003996",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bingham Farms, MI

Sources for this page

Verify at the official NPI Registry.