Betty J Thack Ma PLLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

6401009796 Issued in MI

Legal business name

BETTY J THACK MA PLLC

Doing business as

Betty Thack MA LPC

Practice address

711 West Thirteen Mile Rd
Betty Thack Ma LPC
Madison Heights, MI 48071

Phone

(248) 761-9771

NPI assigned

Dec 17, 2015

Last updated

Jan 16, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Betty Jane Thack, MA LPC NCC

Title

Counselor/Psychotherapist

Phone

(248) 761-9771

Specialties & licenses 1

Addresses

Other names 1

• Betty Thack MA LPC Doing business as

Locations

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

{
    "created_epoch": "1450310400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1452902400000",
    "number": "1235594284",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "711 WEST THIRTEEN MILE RD",
            "address_2": "BETTY THACK MA LPC",
            "city": "MADISON HEIGHTS",
            "state": "MI",
            "postal_code": "48071",
            "telephone_number": "248-761-9771"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "711 WEST THIRTEEN MILE RD",
            "address_2": "BETTY THACK MA LPC",
            "city": "MADISON HEIGHTS",
            "state": "MI",
            "postal_code": "48071",
            "telephone_number": "248-761-9771"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BETTY J THACK MA PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-12-17",
        "last_updated": "2016-01-16",
        "status": "A",
        "authorized_official_last_name": "THACK",
        "authorized_official_first_name": "BETTY",
        "authorized_official_middle_name": "JANE",
        "authorized_official_title_or_position": "COUNSELOR/PSYCHOTHERAPIST",
        "authorized_official_telephone_number": "248-761-9771",
        "authorized_official_credential": "MA LPC NCC"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "MI",
            "license": "6401009796",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Betty Thack MA LPC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jessica L Bergeron, MA, BCBA, LBA
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• Michael Berkovic, DO
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• Ravinder Kaur Bhatia-Deol, MSW
• Bio-Medical Applications of Michigan, Inc. (Bma Madison Heights)
• Sarah Bismack, LMSW
• BJ's Wholesale Club Inc.

• Community/Behavioral Health Agency in Madison Heights, MI
• Providers in Madison Heights, MI by specialty
• Community/Behavioral Health Agency in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2016; 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.