Trevor Charbonneau

Primary specialty

PsychologistTaxonomy code 103T00000X

License

6362009266 Issued in MI

Practice address

5985 W Main St Ste 101
Kalamazoo, MI 49009-8708

Phone

(269) 459-1818

NPI assigned

Mar 27, 2021

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Meredith Psychological and Testing Services, LLC

  • Clinical Psychologist
  • Kalamazoo, MI
  • NPI 1558735266
  NPD (past)

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

{
    "created_epoch": "1616803200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616803200000",
    "number": "1417534199",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5985 W MAIN ST STE 101",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490098708",
            "telephone_number": "269-459-1818"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5985 W MAIN ST STE 101",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490098708",
            "telephone_number": "269-459-1818"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHARBONNEAU",
        "first_name": "TREVOR",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-03-27",
        "last_updated": "2021-03-27",
        "certification_date": "2021-03-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MI",
            "license": "6362009266",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "trevor@kalamazoo-therapist.com",
            "affiliation": "N",
            "endpointDescription": "HIPAA email",
            "address_1": "5985 W Main St Ste 101",
            "city": "Kalamazoo",
            "state": "MI",
            "country_code": "US",
            "postal_code": "490098708",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Felicia Leeann Chapman
• Jamie Marie Chapman, FNP-C
• Mitchell Chapman
• Matthew Perry Chappuies, LPN
• Megan E Charapata, BEHAVIOR TECHNICIAN
• Tracy Charleston-Blakes
• Diana Charnley, PHD, LPC, NCC
• Sarah Elaine Charters, M.D.
• Madison Chase
• Taylor Marie Chastain, B.S., B.A.

• All providers in Kalamazoo, MI
• Psychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2021; 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.