Individual provider Active NPI

Judy A McCown, PH.D.

  • Clinical Psychologist
  • Saint Clair Shores, MI
National Provider Identifier
1164542254
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
6301008870 Issued in MI
Practice address
22811 Greater Mack Ave
Suite L-3
Saint Clair Shores, MI 48080-2021
Phone
(586) 777-3988
NPI assigned
Mar 30, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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 6301008870 MI Primary

Addresses

Primary practice location

22811 Greater Mack Ave
Suite L-3
Saint Clair Shores, MI 48080-2021

Mailing address

22811 Greater Mack Ave
Suite L-3
Saint Clair Shores, MI 48080-2021
Phone (586) 777-3988

Other identifiers 2

IdentifierTypeStateIssuer
6301008870OtherMIPSYCHOLOGIST LICENSE
680EO45650OtherMIBLUE CROSS BLUE SHIELD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
6301008870MIMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
John a Ryan PHD PC Clinical Past Accepting new patients
Lakeshore Psychological Services Past Accepting new patients

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": "1175212800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1164542254",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22811 GREATER MACK AVE",
            "address_2": "SUITE L-3",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480802021",
            "telephone_number": "586-777-3988"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22811 GREATER MACK AVE",
            "address_2": "SUITE L-3",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480802021",
            "telephone_number": "586-777-3988"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCOWN",
        "first_name": "JUDY",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-30",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MI",
            "license": "6301008870",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PSYCHOLOGIST LICENSE",
            "identifier": "6301008870",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "680EO45650",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Clair Shores, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.