Laura W Fadell, LLP

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

6301012038 Issued in MI

Practice address

520 Superior St
Port Huron, MI 48060-3838

Phone

(810) 984-4202

NPI assigned

Aug 19, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

No

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, 2007

Medicare assignment

May accept Medicare assignment

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Bloomfield Consulting, PLLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Bloomfield Hills, MI
  • NPI 1134544331
  NPD (past) Authorized official

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

{
    "created_epoch": "1155945600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1184738676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "520 SUPERIOR ST",
            "city": "PORT HURON",
            "state": "MI",
            "postal_code": "480603838",
            "telephone_number": "810-984-4202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "520 SUPERIOR ST",
            "city": "PORT HURON",
            "state": "MI",
            "postal_code": "480603838",
            "telephone_number": "810-984-4202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FADELL",
        "first_name": "LAURA",
        "middle_name": "W",
        "credential": "LLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-19",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MI",
            "license": "6301012038",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Thomas Kevin Ernst, DPM
• Stephanie Evans, LLMSW
• Eye Care Providers of Michigan PC (Eye Care Center of Port Huron)
• Eye Care Providers of Michigan PC (Eye Care Center of Port Huron)
• Moeta Ziarra Fabelo
• Laurie Lee Fagan, LBSW
• Gudalia Fajardo
• Betty Falecki, NP-C
• Family Dentists, PLLC
• Brian Fanion, LMSW

• Clinical Psychologist in Port Huron, MI
• Providers in Port Huron, MI by specialty
• Clinical Psychologist in Michigan

• 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.
• 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.