NPIMap

Organization Active NPI

Identity Counseling Psychology PLLC

  • Counseling Psychologist
  • Ann Arbor, MI
National Provider Identifier
1346738770
Registry record updated Aug 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Counseling PsychologistTaxonomy code 103TC1900X
Legal business name
IDENTITY COUNSELING PSYCHOLOGY PLLC
Practice address
2350 Washtenaw Ave Ste 4
Ann Arbor, MI 48104
Phone
(734) 645-8944
Fax
(734) 645-8944
NPI assigned
May 1, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 17, 2018

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

Authorized official

Name
Timothy Wilkins
Title
LPC
Phone
(734) 645-8944

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Counseling PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC1900X Primary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X

Addresses

Primary practice location

2350 Washtenaw Ave Ste 4
Ann Arbor, MI 48104

Mailing address

2350 Washtenaw Ave Ste 4
Ann Arbor, MI 48104-4525
Phone (734) 645-8944

Other names 1

  • Wilkins Counseling Psychology Former legal business name

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": "1525132800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1534464000000",
    "number": "1346738770",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2350 WASHTENAW AVE STE 4",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481044525",
            "telephone_number": "734-645-8944",
            "fax_number": "734-645-8944"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2350 WASHTENAW AVE STE 4",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "48104",
            "telephone_number": "734-645-8944",
            "fax_number": "734-645-8944"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDENTITY COUNSELING PSYCHOLOGY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-01",
        "last_updated": "2018-08-17",
        "status": "A",
        "authorized_official_last_name": "WILKINS",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_title_or_position": "LPC",
        "authorized_official_telephone_number": "734-645-8944"
    },
    "taxonomies": [
        {
            "code": "103TC1900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Counseling",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wilkins Counseling Psychology",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Ann Arbor, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2018; 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.