NPIMap

Organization Active NPI

Clarkston Family Therapists LLC

  • Clinical Psychologist
  • Clarkston, MI
National Provider Identifier
1326393752
Registry record updated Nov 29, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
Legal business name
CLARKSTON FAMILY THERAPISTS LLC
Practice address
5639 Sashabaw Rd
Clarkston, MI 48346-3149
Phone
(248) 922-9077
Fax
(248) 922-9040
NPI assigned
Jul 23, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 29, 2012

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

Authorized official

Name
Dr. Francis M Donnelly, PHDNPI 1952480675
Title
Owner
Phone
(248) 922-9077

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
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X MI Primary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X MI

Addresses

Primary practice location

5639 Sashabaw Rd
Clarkston, MI 48346-3149

Mailing address

5639 Sashabaw Rd
Clarkston, MI 48346-3149
Phone (248) 922-9077

Other identifiers 4

IdentifierTypeStateIssuer
6301006011OtherMILICENSE
6301009503OtherMILICENSE
6801068002OtherMILICENSE
103T00000XOtherMITAXONOMY

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20121214000022 MI Part B Supplier - Clinic/Group Practice 8820240047 Receives reassigned benefits from 5 practitioners
Practice locations: Clarkston, MI

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 7

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

NPI Registry JSON

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

{
    "created_epoch": "1343001600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1354147200000",
    "number": "1326393752",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5639 SASHABAW RD",
            "city": "CLARKSTON",
            "state": "MI",
            "postal_code": "483463149",
            "telephone_number": "248-922-9077",
            "fax_number": "248-922-9040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5639 SASHABAW RD",
            "city": "CLARKSTON",
            "state": "MI",
            "postal_code": "483463149",
            "telephone_number": "248-922-9077",
            "fax_number": "248-922-9040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLARKSTON FAMILY THERAPISTS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-23",
        "last_updated": "2012-11-29",
        "status": "A",
        "authorized_official_last_name": "DONNELLY",
        "authorized_official_first_name": "FRANCIS",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "248-922-9077",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "MI",
            "license": null,
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "6301006011",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "6301009503",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "6801068002",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAXONOMY",
            "identifier": "103T00000X",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 Nov 29, 2012; 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.