Active NPI
Thomas Edward Fish, PHD, MA, MFA, CHT
- Mental Health Counselor
- Southgate, MI
National Provider Identifier
1205348117
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 6401007638
- Practice address
- 14799 Dix Toledo Rd
Southgate, MI 48195-2507 - Phone
- (989) 971-9445
- NPI assigned
- Nov 1, 2017
- Sex
- Male
- Sole proprietor
- No
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 | 6401007638 | MI | Primary |
Addresses
Primary practice location
14799 Dix Toledo Rd
Southgate, MI 48195-2507
Mailing address
14799 Dix Toledo Rd
Southgate, MI 48195-2507
Phone (989) 971-9445
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts, Master of Fine Arts, Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6401007638 | MI | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Team Wellness Center | Past | Accepting new patients |
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.
-
- Community Health Clinic/Center
- Detroit, MI
- NPI 1588855100
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1509494400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1509494400000",
"number": "1205348117",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14799 DIX TOLEDO RD",
"city": "SOUTHGATE",
"state": "MI",
"postal_code": "481952507",
"telephone_number": "989-971-9445"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14799 DIX TOLEDO RD",
"city": "SOUTHGATE",
"state": "MI",
"postal_code": "481952507",
"telephone_number": "989-971-9445"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FISH",
"first_name": "THOMAS",
"middle_name": "EDWARD",
"name_prefix": "Dr.",
"credential": "PHD, MA, MFA, CHT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-11-01",
"last_updated": "2017-11-01",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "MI",
"license": "6401007638",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Southgate, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2017; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.