Active NPI
Mary Weatherston, PHD
- Psychologist
- Birmingham, MI
National Provider Identifier
1366417412
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 6301008672
- Practice address
- 725 S Adams Rd
Ste 244
Birmingham, MI 48009-6902 - Phone
- (248) 642-2411
- NPI assigned
- Feb 22, 2006
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | 6301008672 | MI | Primary |
Addresses
Primary practice location
725 S Adams Rd
Ste 244
Birmingham, MI 48009-6902
Mailing address
725 S Adams Rd
Ste 244
Birmingham, MI 48009-6902
Phone (248) 642-2411
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)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6301008672 | MI | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1140566400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1276473600000",
"number": "1366417412",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "725 S ADAMS RD",
"address_2": "STE 244",
"city": "BIRMINGHAM",
"state": "MI",
"postal_code": "480096902",
"telephone_number": "248-642-2411"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "725 S ADAMS RD",
"address_2": "STE 244",
"city": "BIRMINGHAM",
"state": "MI",
"postal_code": "480096902",
"telephone_number": "248-642-2411"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WEATHERSTON",
"first_name": "MARY",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-02-22",
"last_updated": "2010-06-14",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MI",
"license": "6301008672",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Birmingham, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.