Active NPI
Thomas E. Laberteaux, PH.D.
- Clinical Psychologist
- Ada, MI
National Provider Identifier
1568585255
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 6301000979
- Practice address
- 4670 Fulton St E Ste 101
Ada, MI 49301-8409 - Phone
- (616) 975-3160
- Fax
- (616) 975-3163
- NPI assigned
- Apr 9, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 6301000979 | MI | |
| Cognitive & Behavioral Psychologist | 103TB0200X | 6301000979 | MI | |
| Clinical Psychologist | 103TC0700X | 6301000979 | MI | Primary |
| Clinical Child & Adolescent Psychologist | 103TC2200X | 6301000979 | MI |
Addresses
Primary practice location
4670 Fulton St E Ste 101
Ada, MI 49301-8409
Mailing address
4670 Fulton St E Ste 101
Ada, MI 49301-8409
Phone (616) 975-3160
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 |
|---|---|---|---|
| 6301000979 | MI | MD | Cognitive & Behavioral Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| David R Macrae, PH.D., P.C. | Clinical | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Clinical Psychologist
- Grand Rapids, MI
- NPI 1154507325
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176076800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1238716800000",
"number": "1568585255",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4670 FULTON ST E STE 101",
"city": "ADA",
"state": "MI",
"postal_code": "493018409",
"telephone_number": "616-975-3160",
"fax_number": "616-975-3163"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4670 FULTON ST E STE 101",
"city": "ADA",
"state": "MI",
"postal_code": "493018409",
"telephone_number": "616-975-3160",
"fax_number": "616-975-3163"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LABERTEAUX",
"first_name": "THOMAS",
"middle_name": "E.",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-04-09",
"last_updated": "2009-04-03",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MI",
"license": "6301000979",
"primary": false
},
{
"code": "103TB0200X",
"taxonomy_group": "",
"desc": "Psychologist, Cognitive & Behavioral",
"state": "MI",
"license": "6301000979",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MI",
"license": "6301000979",
"primary": true
},
{
"code": "103TC2200X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": "MI",
"license": "6301000979",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ada, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.