Organization Active NPI

Good Mind PLLC

  • Adult Mental Health Clinic/Center
  • Grosse Pointe Park, MI
National Provider Identifier
1184214942
Registry record updated Aug 1, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X
Legal business name
GOOD MIND PLLC
Practice address
15324 E Jefferson Ave Ste 2
Grosse Pointe Park, MI 48230-1378
Phone
(586) 899-0814
NPI assigned
Jan 25, 2021
Last updated
Aug 1, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 1, 2022

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

Authorized official

Name
Yolanda Dobbyn
Title
Office Manager
Phone
(586) 899-0814

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Mental Health Clinic/Center 261QM0850X NU Primary

Addresses

Primary practice location

15324 E Jefferson Ave Ste 2
Grosse Pointe Park, MI 48230-1378

Mailing address

15324 E Jefferson Ave Ste 2
Grosse Pointe Park, MI 48230-1378
Phone (586) 899-0814

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL goodmindmd.com Other

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220726000647 MI Part B Supplier - Clinic/Group Practice 9830570605 Receives reassigned benefits from 2 practitioners
Practice locations: Grosse Pointe Park, MI

National Provider Directory

National Provider Directory

Locations

15324 E Jefferson Ave
Ste 2
Grosse Pointe Park, MI 48230
Phone (586) 899-0814

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1611532800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1659312000000",
    "number": "1184214942",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15324 E JEFFERSON AVE STE 2",
            "city": "GROSSE POINTE PARK",
            "state": "MI",
            "postal_code": "482301378",
            "telephone_number": "586-899-0814"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15324 E JEFFERSON AVE STE 2",
            "city": "GROSSE POINTE PARK",
            "state": "MI",
            "postal_code": "482301378",
            "telephone_number": "586-899-0814"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOOD MIND PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-01-25",
        "last_updated": "2022-08-01",
        "certification_date": "2022-08-01",
        "status": "A",
        "authorized_official_last_name": "DOBBYN",
        "authorized_official_first_name": "YOLANDA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "586-899-0814"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "goodmindmd.com",
            "affiliation": "N",
            "endpointDescription": "web sight",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "Grosse Pointe Park",
            "address_1": "15324 E Jefferson Ave Ste 2",
            "city": "Grosse Pointe Park",
            "state": "MI",
            "country_code": "US",
            "postal_code": "482301378",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Grosse Pointe Park, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.