Active NPI
Whitney Kantack, PHD, LP
- Clinical Psychologist
- Troy, MI
National Provider Identifier
1124361308
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 6301015876
- Practice address
- 2075 W Big Beaver Rd
Suite 520
Troy, MI 48084-3407 - Phone
- (248) 646-6659
- NPI assigned
- Apr 5, 2013
- Sex
- Female
- Sole proprietor
- No
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 | 6301015876 | MI | Primary |
Addresses
Primary practice location
2075 W Big Beaver Rd
Suite 520
Troy, MI 48084-3407
Mailing address
2075 W Big Beaver Rd
Suite 520
Troy, MI 48084-3407
Phone (248) 646-6659
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20161215002235 | MI | Practitioner - Clinical Psychologist | 2567742265 | Practice locations: Birmingham, MI |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 2014
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
975 E Maple Rd
Suite 212
Birmingham, MI 48009-6420
Phone (928) 916-2911
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6301015876 | MI | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1365120000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1445385600000",
"number": "1124361308",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2075 W BIG BEAVER RD",
"address_2": "SUITE 520",
"city": "TROY",
"state": "MI",
"postal_code": "480843407",
"telephone_number": "248-646-6659"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2075 W BIG BEAVER RD",
"address_2": "SUITE 520",
"city": "TROY",
"state": "MI",
"postal_code": "480843407",
"telephone_number": "248-646-6659"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KANTACK",
"first_name": "WHITNEY",
"credential": "PHD, LP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-04-05",
"last_updated": "2015-10-21",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MI",
"license": "6301015876",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Troy, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.