NPIMap

Organization Active NPI

Center for Brainwave Balance PLLC

  • Psychologist
  • Ann Arbor, MI
National Provider Identifier
1588091409
Registry record updated Feb 6, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
5261 Issued in OH
Legal business name
CENTER FOR BRAINWAVE BALANCE PLLC
Practice address
2245 S State St
Suite 1200 #1a
Ann Arbor, MI 48104-6184
Phone
(734) 585-0952
Fax
(734) 585-0954
NPI assigned
Oct 9, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 6, 2014

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

Authorized official

Name
Dr. Debra Hutton, PH.D.
Title
Clinical Psychologist/President
Phone
(734) 585-0952

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103T00000X 5261 OH Primary

Addresses

Primary practice location

2245 S State St
Suite 1200 #1a
Ann Arbor, MI 48104-6184

Mailing address

2245 S State St
Suite 1200 #1a
Ann Arbor, MI 48104-6184
Phone (734) 585-0952

National Provider Directory

National Provider Directory

Locations

2245 S State St
Ste 1200
Ann Arbor, MI 48104
Phone (734) 585-0952

NPI Registry JSON

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

{
    "created_epoch": "1381276800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1391644800000",
    "number": "1588091409",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2245 S STATE ST",
            "address_2": "SUITE 1200 #1A",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481046184",
            "telephone_number": "734-585-0952",
            "fax_number": "734-585-0954"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2245 S STATE ST",
            "address_2": "SUITE 1200 #1A",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481046184",
            "telephone_number": "734-585-0952",
            "fax_number": "734-585-0954"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTER FOR BRAINWAVE BALANCE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-09",
        "last_updated": "2014-02-06",
        "status": "A",
        "authorized_official_last_name": "HUTTON",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_title_or_position": "CLINICAL PSYCHOLOGIST/PRESIDENT",
        "authorized_official_telephone_number": "734-585-0952",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist",
            "state": "OH",
            "license": "5261",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ann Arbor, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2014; 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.