NPIMap

Organization Active NPI

McLaren Bay Region

  • Cognitive & Behavioral Psychologist
  • Bay City, MI
National Provider Identifier
1386069110
Registry record updated Aug 9, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cognitive & Behavioral PsychologistTaxonomy code 103TB0200X
License
4703086129 Issued in MI
Legal business name
MCLAREN BAY REGION
Practice address
690 S Trumbull St
Bay City, MI 48708
Phone
(989) 922-4900
Fax
(989) 922-4911
NPI assigned
Mar 4, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 9, 2018

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

Authorized official

Name
Danielle C Jacks Porter
Title
Cfo
Phone
(989) 894-3838

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cognitive & Behavioral PsychologistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 103TB0200X 4703086129 MI Primary

Addresses

Primary practice location

690 S Trumbull St
Bay City, MI 48708

Mailing address

690 S Trumbull St
Bay City, MI 48708-7692
Phone (989) 922-4900

Other identifiers 1

IdentifierTypeStateIssuer
470386129OtherMISTATE LICENSE

National Provider Directory

National Provider Directory
Tax ID family
Bay Medical Center16 organizations share this tax ID, including this one

Other organizations with this tax ID 15

Organizations that report the same tax identification number in the National Provider Directory.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1393891200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1533772800000",
    "number": "1386069110",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "690 S TRUMBULL ST",
            "city": "BAY CITY",
            "state": "MI",
            "postal_code": "487087692",
            "telephone_number": "989-922-4900",
            "fax_number": "989-922-4911"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "690 S TRUMBULL ST",
            "city": "BAY CITY",
            "state": "MI",
            "postal_code": "48708",
            "telephone_number": "989-922-4900",
            "fax_number": "989-922-4911"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MCLAREN BAY REGION",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-04",
        "last_updated": "2018-08-09",
        "status": "A",
        "authorized_official_last_name": "JACKS PORTER",
        "authorized_official_first_name": "DANIELLE",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "989-894-3838"
    },
    "taxonomies": [
        {
            "code": "103TB0200X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": "MI",
            "license": "4703086129",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "470386129",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bay City, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 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.