Active NPI
Stacia Jean Ebelt
- Clinical Psychologist
- Taylor, MI
National Provider Identifier
1316721400
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 6362010045
- Practice address
- 20300 Superior Rd
Taylor, MI 48180-6331 - Phone
- (734) 785-7700
- NPI assigned
- Aug 21, 2023
- Last updated
- Sep 11, 2024
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 6362010045 | MI | Primary |
Addresses
Primary practice location
20300 Superior Rd
Taylor, MI 48180-6331
Mailing address
12142 Lapeer Rd
Davison, MI 48423-8119
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6362010045 | MI | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1692576000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1726012800000",
"number": "1316721400",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12142 LAPEER RD",
"city": "DAVISON",
"state": "MI",
"postal_code": "484238119"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "20300 SUPERIOR RD",
"city": "TAYLOR",
"state": "MI",
"postal_code": "481806331",
"telephone_number": "734-785-7700"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EBELT",
"first_name": "STACIA",
"middle_name": "JEAN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-08-21",
"last_updated": "2024-09-11",
"certification_date": "2024-09-11",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MI",
"license": "6362010045",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Taylor, MI
- Nicole Linette Dykes
- Eai Employment Resources, Inc.
- Eai Employment Resources, Inc. (Engaging Adults In Interaction Adult Day Care)
- Early Solutions Clinic
- East Pointe Psychiatric Services, P.C.
- Edge RX (Taylor Apothecary)
- Niquitisha Edmonds
- Victoria Christine Edwards
- Ehab Brikho MD PC
- Wassim Walid El-Sayed, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.