Individual provider Active NPI

Louise Anne Weller, PHD

  • Clinical Psychologist
  • Plymouth, MI
National Provider Identifier
1396786349
Registry record updated Dec 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
6301016196 Issued in MI
Practice address
340 N Main St Ste 200
Plymouth, MI 48170-1250
Phone
(734) 335-0028
Fax
(734) 335-3931
NPI assigned
Jun 9, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 6, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 016136-1 NY
Clinical Psychologist 103TC0700X 6301016196 MI Primary

Addresses

Primary practice location

340 N Main St Ste 200
Plymouth, MI 48170-1250

Mailing address

340 N Main St Ste 200
Plymouth, MI 48170-1250
Phone (734) 335-0028

Other identifiers 2

IdentifierTypeStateIssuer
6301016196OtherMILICENSE TO PRACTICE AS PSYCHOLOGIST
016136OtherNYPSYCHOLOGIST STATE LICENS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160628002380 MI Practitioner - Clinical Psychologist 9638460249 Reassigns benefits to 2 organizations
Practice locations: Plymouth, MI

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Simply Mindful Counseling LLCGroup PAC ID 6800282963, 12 clinicians

Practice addresses (Care Compare)

340 N Main St
Suite 201
Plymouth, MI 48170-1290
Phone (734) 335-0605

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
6301016196MIMDClinical Psychologist
016136-1NYMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Thrive Counseling LLC CurrentSince Sep 16, 2021 Accepting new patients
Simply Mindful Counseling, LLC CurrentSince Jan 1, 2022 Accepting new patients

Locations

31000 Lahser Rd
Ste 5
Beverly Hills, MI 48025
Phone (248) 644-2175

340 N Main St
Ste 200
Plymouth, MI 48170
Phone (734) 335-0028

340 N Main St
Ste 201
Plymouth, MI 48170
Phone (734) 335-0605

7333 Triangle Dr
Sterling Hts, MI 48314
Phone (248) 686-3347

1000 Jefferson St
Ste 2C
Lynchburg, VA 24504
Phone (434) 528-3263

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1149811200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701820800000",
    "number": "1396786349",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "340 N MAIN ST STE 200",
            "city": "PLYMOUTH",
            "state": "MI",
            "postal_code": "481701250",
            "telephone_number": "734-335-0028"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "340 N MAIN ST STE 200",
            "city": "PLYMOUTH",
            "state": "MI",
            "postal_code": "481701250",
            "telephone_number": "734-335-0028",
            "fax_number": "734-335-3931"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WELLER",
        "first_name": "LOUISE",
        "middle_name": "ANNE",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-06-09",
        "last_updated": "2023-12-06",
        "certification_date": "2023-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NY",
            "license": "016136-1",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MI",
            "license": "6301016196",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE TO PRACTICE  AS PSYCHOLOGIST",
            "identifier": "6301016196",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PSYCHOLOGIST STATE LICENS",
            "identifier": "016136",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Plymouth, MI

Sources for this page

Verify at the official NPI Registry.