NPIMap

Organization Active NPI

Lake Orion Counseling Center

  • Psychologist
  • Clarkston, MI
National Provider Identifier
1255759486
Registry record updated Aug 18, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
6301015095 Issued in MI
Legal business name
LAKE ORION COUNSELING CENTER
Practice address
3604 Clarkston Rd
Clarkston, MI 48348-5215
Phone
(248) 595-9969
Fax
(248) 814-0361
NPI assigned
Apr 4, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 18, 2021

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

Authorized official

Name
Dr. Adam Ross Pasciak, PHD, LPNPI 1548569049
Title
Clinical Psychologist
Phone
(248) 807-9894

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103T00000X 6301015095 MI Primary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X

Addresses

Primary practice location

3604 Clarkston Rd
Clarkston, MI 48348-5215

Mailing address

3604 Clarkston Rd
Clarkston, MI 48348-5215
Phone (248) 595-9969

Other identifiers 1

IdentifierTypeStateIssuer
6301015095MedicaidMI

Other names 1

  • Lake Orion Counseling Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140612001353 MI Part B Supplier - Clinic/Group Practice 3870717838 Receives reassigned benefits from 8 practitioners
Practice locations: Clarkston, MI

National Provider Directory

National Provider Directory

Locations

3604 Clarkston Rd
Clarkston, MI 48348
Phone (248) 595-9969

Practitioners & affiliated clinicians

Practitioners 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1396569600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1629244800000",
    "number": "1255759486",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3604 CLARKSTON RD",
            "city": "CLARKSTON",
            "state": "MI",
            "postal_code": "483485215",
            "telephone_number": "248-595-9969"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3604 CLARKSTON RD",
            "city": "CLARKSTON",
            "state": "MI",
            "postal_code": "483485215",
            "telephone_number": "248-595-9969",
            "fax_number": "248-814-0361"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE ORION COUNSELING CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-04-04",
        "last_updated": "2021-08-18",
        "certification_date": "2021-08-18",
        "status": "A",
        "authorized_official_last_name": "PASCIAK",
        "authorized_official_first_name": "ADAM",
        "authorized_official_middle_name": "ROSS",
        "authorized_official_title_or_position": "CLINICAL PSYCHOLOGIST",
        "authorized_official_telephone_number": "248-807-9894",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD, LP"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": "MI",
            "license": "6301015095",
            "primary": true
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6301015095",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lake Orion Counseling Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Lake Orion Counseling Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Clarkston, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2021; 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.