NPIMap

Organization Active NPI

Downriver Mental Health Clinic PC

  • Psychologist
  • Taylor, MI
National Provider Identifier
1104930130
Registry record updated Mar 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
Legal business name
DOWNRIVER MENTAL HEALTH CLINIC PC
Practice address
20500 Eureka Rd
Suite 200
Taylor, MI 48180-6394
Phone
(734) 285-8282
Fax
(734) 281-0402
NPI assigned
Aug 18, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 1, 2024

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

Authorized official

Name
Ryan Pardo
Title
Chief Legal Officer
Phone
(206) 399-1493

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Professional CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP2500X
PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103T00000X Primary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X

Addresses

Primary practice location

20500 Eureka Rd
Suite 200
Taylor, MI 48180-6394

Mailing address

4800 N Scottsdale Rd Ste 2500
Scottsdale, AZ 85251-7630
Phone (480) 524-0990

Other identifiers 8

IdentifierTypeStateIssuer
003433000 188713000OtherMIMAGELLAN
4441363OtherMITEAMSTERS
7509106200OtherBCBS OF MI:MENTAL HEALTH
BM820042OtherMIMCARE
004241F3OtherMIHAP
101039OtherMIVALUE OPTIONS
511213OtherCARE CHOICES
4449395OtherMIAETNA

Other names 1

  • ADVANCED COUNSELING SERVICES PC Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040505000533 MI Part B Supplier - Clinic/Group Practice 7911995139 Receives reassigned benefits from 434 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Grand Rapids, MI; Taylor, MI; Southfield, MI; Saint Clair Shores, MI; Portage, MI; Novi, MI; New Hudson, MI; Lansing, MI…

Other NPIs on the same Medicare enrollment 6

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

2350 Green Rd
Ste 150160
Ann Arbor, MI 48105
Phone (734) 285-8282

2251 N Squirrel Rd
Ste 319
Auburn Hills, MI 48326

2251 N Squirrel Rd
Ste 315
Auburn Hills, MI 48326

2251 N Squirrel Rd
Ste 316
Auburn Hills, MI 48326

2251 N Squirrel Rd
Ste 317
Auburn Hills, MI 48326

2251 N Squirrel Rd
Ste 318
Auburn Hills, MI 48326

30700 Telegraph Rd
Ste 2560
Bingham Farms, MI 48025
Phone (248) 203-1770

1760 S Telegraph Rd
Ste 220
Bloomfield Hills, MI 48302
Phone (248) 587-7618

1760 S Telegraph Rd
Ste 200220
Bloomfield Township, MI 48302
Phone (734) 285-8282

5958 N Canton Center Rd
Ste 800
Canton, MI 48187

7300 Dixie Hwy
Ste 312
Clarkston, MI 48346
Phone (248) 922-2300

5825 S Main St
Ste 104A
Clarkston, MI 48346
Phone (248) 922-2300

1400 Abbot Rd
Ste 400
East Lansing, MI 48823
Phone (810) 220-2787

3950 Sparks Dr SE
Ste 103
Grand Rapids, MI 49546
Phone (616) 455-5000

19501 E 8 Mile Rd
St Clr Shores, MI 48080
Phone (810) 777-9000

20500 Eureka Rd
Ste 200
Taylor, MI 48180
Phone (734) 285-8282

Practitioners & affiliated clinicians

Practitioners 392

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 392

NPI Registry JSON

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

{
    "created_epoch": "1155859200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709251200000",
    "number": "1104930130",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4800 N SCOTTSDALE RD STE 2500",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852517630",
            "telephone_number": "480-524-0990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20500 EUREKA RD",
            "address_2": "SUITE 200",
            "city": "TAYLOR",
            "state": "MI",
            "postal_code": "481806394",
            "telephone_number": "734-285-8282",
            "fax_number": "734-281-0402"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DOWNRIVER MENTAL HEALTH CLINIC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-18",
        "last_updated": "2024-03-01",
        "certification_date": "2024-03-01",
        "status": "A",
        "authorized_official_last_name": "PARDO",
        "authorized_official_first_name": "RYAN",
        "authorized_official_title_or_position": "CHIEF LEGAL OFFICER",
        "authorized_official_telephone_number": "206-399-1493"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAGELLAN",
            "identifier": "003433000 188713000",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TEAMSTERS",
            "identifier": "4441363",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF MI:MENTAL HEALTH",
            "identifier": "7509106200",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MCARE",
            "identifier": "BM820042",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HAP",
            "identifier": "004241F3",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VALUE OPTIONS",
            "identifier": "101039",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CARE CHOICES",
            "identifier": "511213",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "4449395",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ADVANCED COUNSELING SERVICES PC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Taylor, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.