Active NPI
Susan E. Dettloff, LMSW
- Mental Health Counselor
- Saint Clair Shores, MI
National Provider Identifier
1164580460
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 6801033706
- Practice address
- 24715 Little Mack Ave
Ste. 200
Saint Clair Shores, MI 48080-3207 - Phone
- (586) 777-9000
- Fax
- (586) 777-0823
- NPI assigned
- Dec 5, 2006
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 6801033706 | MI | Primary |
Addresses
Primary practice location
24715 Little Mack Ave
Ste. 200
Saint Clair Shores, MI 48080-3207
Mailing address
24715 Little Mack Ave
Ste. 200
Saint Clair Shores, MI 48080-3207
Phone (586) 777-9000
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Downriver Mental Health Clinic PC | Mental Health | Past | Accepting new patients |
Interoperability endpoints
- lifestancehealth.susandettloff@150339.advancedmd-direct.com
Organizations & group practices 1
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": "1165276800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1164580460",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "24715 LITTLE MACK AVE",
"address_2": "STE. 200",
"city": "SAINT CLAIR SHORES",
"state": "MI",
"postal_code": "480803207",
"telephone_number": "586-777-9000",
"fax_number": "586-777-0823"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "24715 LITTLE MACK AVE",
"address_2": "STE. 200",
"city": "SAINT CLAIR SHORES",
"state": "MI",
"postal_code": "480803207",
"telephone_number": "586-777-9000",
"fax_number": "586-777-0823"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DETTLOFF",
"first_name": "SUSAN",
"middle_name": "E.",
"name_prefix": "Mrs.",
"credential": "LMSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-12-05",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "MI",
"license": "6801033706",
"primary": true
}
],
"identifiers": [],
"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.