Linda D Theis, L.L. P

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

6301015848 Issued in MI

Practice address

6035 Gonyer Rd SW
Fife Lake, MI 49633-8214

Phone

(231) 715-9381

NPI assigned

Apr 9, 2014

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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

Specialty

Clinical Psychologist

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Old Town Psychological ServicesGroup PAC ID 2466600101, 8 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

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.

• Old Town Psychological Services

  • Clinical Psychologist
  • Traverse City, MI
  • NPI 1093989162
  Medicare reassignment Care Compare group NPD
• Mindful Performance Therapy, PLLC

  • Clinical Psychologist
  • Traverse City, MI
  • NPI 1851972814
  NPD (past)
• Old Town Psychological Services-Gaylord

  • Clinical Child & Adolescent Psychologist
  • Gaylord, MI
  • NPI 1750659249
  NPD (past)

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

{
    "created_epoch": "1397001600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1397001600000",
    "number": "1124447859",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6035 GONYER RD SW",
            "city": "FIFE LAKE",
            "state": "MI",
            "postal_code": "496338214",
            "telephone_number": "231-715-9381"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6035 GONYER RD SW",
            "city": "FIFE LAKE",
            "state": "MI",
            "postal_code": "496338214",
            "telephone_number": "231-715-9381"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THEIS",
        "first_name": "LINDA",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "L.L. P",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-04-09",
        "last_updated": "2014-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MI",
            "license": "6301015848",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Forest Area Medical Centers PC
• Heather Nicole Jacques
• Dagny Jean Monette
• Elizabeth Renee Ransom
• Samantha Kaylee Steinebach
• TNT Nursing Services LLC
• Melinda Ann Walker, LPC
• Jarin A Weber, MSW
• Lisa Woodcox

• Clinical Psychologist in Fife Lake, MI
• Providers in Fife Lake, MI by specialty
• Clinical Psychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2014; 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.

Verify at the official NPI Registry.