Great Lakes Psychological Associates PLLC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

6301014926 Issued in MI

Legal business name

GREAT LAKES PSYCHOLOGICAL ASSOCIATES PLLC

Practice address

400 S University Ave
Mt Pleasant, MI 48858-3170

Phone

(989) 317-3188

Fax

(989) 202-1888

NPI assigned

Sep 15, 2015

Organization subpart

No

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

Authorized official

Name

Dr. Jeremy Adam Moeggenberg, PSYDNPI 1558593707

Title

Owner

Phone

(989) 317-3188

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jeremy Adam Moeggenberg, PSYD.

  • Clinical Psychologist
  • Mt Pleasant, MI
  • NPI 1558593707
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1442275200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1546560000000",
    "number": "1205205747",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 S UNIVERSITY AVE",
            "city": "MT PLEASANT",
            "state": "MI",
            "postal_code": "488583170",
            "telephone_number": "989-317-3188",
            "fax_number": "989-202-1888"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 S UNIVERSITY AVE",
            "city": "MT PLEASANT",
            "state": "MI",
            "postal_code": "488583170",
            "telephone_number": "989-317-3188",
            "fax_number": "989-202-1888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES PSYCHOLOGICAL ASSOCIATES PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-15",
        "last_updated": "2019-01-04",
        "status": "A",
        "authorized_official_last_name": "MOEGGENBERG",
        "authorized_official_first_name": "JEREMY",
        "authorized_official_middle_name": "ADAM",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "989-317-3188",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "MI",
            "license": "6301014926",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Angela S Gorski
• Laura Christine Gourlay, M.A.
• Jeffery Ryan Govitz
• Christine L Gransden, NP
• Great Lakes Medical PC
• Great Lakes Spine Sports & Pain, PLLC
• Greater Michigan Spine & Neurologic Institute, PC
• Allison Green
• Katelyn Rae Green
• Holli Greenacre, MS

• Clinical Psychologist in Mt Pleasant, MI
• Providers in Mt Pleasant, MI by specialty
• Clinical Psychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2019; 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.