Active NPI
George Mark Daigle, PHD
- Clinical Psychologist
- Northville, MI
National Provider Identifier
1437357613
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 6301003306
- Practice address
- 215 E Main St
#201
Northville, MI 48167-1681 - Phone
- (248) 348-1100
- Fax
- (248) 348-3410
- NPI assigned
- Jul 10, 2007
- Sex
- Male
- Sole proprietor
- No
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 | 6301003306 | MI | Primary |
Addresses
Primary practice location
215 E Main St
#201
Northville, MI 48167-1681
Mailing address
215 E Main St
#201
Northville, MI 48167-1681
Phone (248) 348-1100
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 143449 | Other | MI | VALUE OPTIONS |
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bobbi Ebsen Psychotherapy LLC | Past | Accepting new patients | |
| Psychotherapy & Counseling Services, Inc. | Clinical | Past | Accepting new patients |
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.
-
- Professional Counselor
- Northville, MI
- NPI 1801083183
Clinical
-
- Clinical Social Worker
- Albuquerque, NM
- NPI 1689012379
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1184025600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1184025600000",
"number": "1437357613",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "215 E MAIN ST",
"address_2": "#201",
"city": "NORTHVILLE",
"state": "MI",
"postal_code": "481671681",
"telephone_number": "248-348-1100",
"fax_number": "248-348-3410"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "215 E MAIN ST",
"address_2": "#201",
"city": "NORTHVILLE",
"state": "MI",
"postal_code": "481671681",
"telephone_number": "248-348-1100",
"fax_number": "248-348-3410"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAIGLE",
"first_name": "GEORGE",
"middle_name": "MARK",
"name_prefix": "Mr.",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-07-10",
"last_updated": "2007-07-10",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MI",
"license": "6301003306",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VALUE OPTIONS",
"identifier": "143449",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Northville, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.