NPIMap

Organization Active NPI

List Psychological Services, PLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Caro, MI
National Provider Identifier
1265685903
Registry record updated Dec 27, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
License
SA0790042 Issued in MI
Legal business name
LIST PSYCHOLOGICAL SERVICES, PLC
Practice address
467 N State St
Caro, MI 48723-1539
Phone
(989) 672-2016
Fax
(989) 672-2017
NPI assigned
Oct 28, 2008
Last updated
Dec 27, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 27, 2016

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

Authorized official

Name
Jacqueline Thompson
Title
Coo
Phone
(989) 672-6160

Specialties & licenses 9

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X SA0790042 MI Primary
Counselor 101Y00000X
Addiction (Substance Use Disorder) Counselor 101YA0400X
Mental Health Counselor 101YM0800X
Psychologist 103T00000X
Clinical Psychologist 103TC0700X
Social Worker 104100000X
Clinical Social Worker 1041C0700X
Psychiatry Physician 2084P0800X

Addresses

Primary practice location

467 N State St
Caro, MI 48723-1539

Mailing address

443 N State St
Caro, MI 48723-1539
Phone (989) 672-6160

Other identifiers 1

IdentifierTypeStateIssuer
034530OtherMIVALUE OPTION

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031110000689 MI Part B Supplier - Clinic/Group Practice 6709799323 Receives reassigned benefits from 28 practitioners
10 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Lapeer, MI; Sandusky, MI; Saginaw, MI; Pigeon, MI; Caro, MI; Bay City, MI; Bad Axe, MI
O20040322001040 MI Part B Supplier - Clinic/Group Practice 6709799323 Receives reassigned benefits from 8 practitioners
10 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Sandusky, MI; Saginaw, MI; Pigeon, MI; Lapeer, MI; Caro, MI; Bay City, MI; Bad Axe, MI

Other NPIs on the same Medicare enrollment 10

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

467 N State St
Caro, MI 48723
Phone (989) 672-6160

5024 N Center Rd
Saginaw, MI 48604
Phone (989) 672-6160

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1225152000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1482796800000",
    "number": "1265685903",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "443 N STATE ST",
            "city": "CARO",
            "state": "MI",
            "postal_code": "487231539",
            "telephone_number": "989-672-6160",
            "fax_number": "989-672-6272"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "467 N STATE ST",
            "city": "CARO",
            "state": "MI",
            "postal_code": "487231539",
            "telephone_number": "989-672-2016",
            "fax_number": "989-672-2017"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIST PSYCHOLOGICAL SERVICES, PLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-28",
        "last_updated": "2016-12-27",
        "status": "A",
        "authorized_official_last_name": "THOMPSON",
        "authorized_official_first_name": "JACQUELINE",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "989-672-6160"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "MI",
            "license": "SA0790042",
            "primary": true
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VALUE OPTION",
            "identifier": "034530",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Caro, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2016; 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.