Active NPI
Anne Van Dyke, PH.D.
- Clinical Psychologist
- Sterling HTS, MI
National Provider Identifier
1396712238
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 6301005409
- Practice address
- 4171 Nathan W
Sterling HTS, MI 48310-2650 - Phone
- (248) 660-5034
- NPI assigned
- Feb 28, 2006
- Last updated
- Oct 29, 2024
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 6301005409 | MI | Primary |
Addresses
Primary practice location
4171 Nathan W
Sterling HTS, MI 48310-2650
Mailing address
4171 Nathan W
Sterling HTS, MI 48310-2650
Phone (248) 660-5034
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 680F371350 | Other | MI | BCBSM |
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 |
|---|---|---|---|
| 6301005409 | MI | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1141084800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1730160000000",
"number": "1396712238",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4171 NATHAN W",
"city": "STERLING HTS",
"state": "MI",
"postal_code": "483102650",
"telephone_number": "248-660-5034"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4171 NATHAN W",
"city": "STERLING HTS",
"state": "MI",
"postal_code": "483102650",
"telephone_number": "248-660-5034"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VAN DYKE",
"first_name": "ANNE",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-02-28",
"last_updated": "2024-10-29",
"certification_date": "2024-10-29",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Psychologist, Clinical",
"state": "MI",
"license": "6301005409",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBSM",
"identifier": "680F371350",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Sterling HTS, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 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.