Innovative Child & Family Services

Primary specialty

Adolescent and Children Mental Health Clinic/CenterTaxonomy code 261QM0855X

Legal business name

INNOVATIVE CHILD & FAMILY SERVICES

Practice address

3721 W Michigan Ave
Lansing, MI 48917-3693

Phone

(517) 515-6176

NPI assigned

Nov 18, 2020

Organization subpart

No

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

Authorized official

Name

Mr. Ricardo David Tillery, LMSW

Title

Ceo

Phone

(517) 703-3387

Specialties & licenses 10

Addresses

Locations

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

{
    "created_epoch": "1605657600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1605657600000",
    "number": "1497358865",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3721 W MICHIGAN AVE",
            "city": "LANSING",
            "state": "MI",
            "postal_code": "489173693",
            "telephone_number": "517-515-6176"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3721 W MICHIGAN AVE",
            "city": "LANSING",
            "state": "MI",
            "postal_code": "489173693",
            "telephone_number": "517-515-6176"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNOVATIVE CHILD & FAMILY SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-11-18",
        "last_updated": "2020-11-18",
        "certification_date": "2020-11-18",
        "status": "A",
        "authorized_official_last_name": "TILLERY",
        "authorized_official_first_name": "RICARDO",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "517-703-3387",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LMSW"
    },
    "taxonomies": [
        {
            "code": "174200000X",
            "taxonomy_group": "",
            "desc": "Meals",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "177F00000X",
            "taxonomy_group": "",
            "desc": "Lodging",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251300000X",
            "taxonomy_group": "",
            "desc": "Local Education Agency (LEA)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251K00000X",
            "taxonomy_group": "",
            "desc": "Public Health or Welfare",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QA0005X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Family Planning Facility",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM3000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medically Fragile Infants and Children Day Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "311Z00000X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Adolescent and Children Mental Health Clinic/Center in Lansing, MI
• Providers in Lansing, MI by specialty
• Adolescent and Children Mental Health Clinic/Center in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2020; 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.