Individual provider Active NPI

Michelle L Culton-Ekstrom, MA,LLP

  • Psychologist
  • Lapeer, MI
National Provider Identifier
1164869665
Registry record updated May 24, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
6301008265 Issued in MI
Practice address
1570 Suncrest Dr
Lapeer, MI 48446-1154
Phone
(810) 667-0500
NPI assigned
May 24, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 24, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 6301008265 MI Primary

Addresses

Primary practice location

1570 Suncrest Dr
Lapeer, MI 48446-1154

Mailing address

1570 Suncrest Dr
Lapeer, MI 48446-1154

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)
Not enrolled
Credentials
Master of Arts

State licenses

LicenseStateTypeSpecialty
6301008265MIMDPsychologist

NPI Registry JSON

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

{
    "created_epoch": "1369353600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1369353600000",
    "number": "1164869665",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1570 SUNCREST DR",
            "city": "LAPEER",
            "state": "MI",
            "postal_code": "484461154"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1570 SUNCREST DR",
            "city": "LAPEER",
            "state": "MI",
            "postal_code": "484461154",
            "telephone_number": "810-667-0500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CULTON-EKSTROM",
        "first_name": "MICHELLE",
        "middle_name": "L",
        "credential": "MA,LLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-05-24",
        "last_updated": "2013-05-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MI",
            "license": "6301008265",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lapeer, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2013; 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.