Organization Active NPI

Connally Counseling

  • Clinical Social Worker
  • Ann Arbor, MI
National Provider Identifier
1598193310
Registry record updated Aug 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
6801095252 Issued in MI
Legal business name
CONNALLY COUNSELING
Practice address
3300 Washtenaw Ave Ste 260
Ann Arbor, MI 48104-5184
Phone
(734) 277-7565
Fax
(734) 215-2363
NPI assigned
Oct 15, 2013
Last updated
Aug 5, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 5, 2021

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

Authorized official

Name
Dalton Killian Connally, PHDNPI 1669815288
Title
Owner
Phone
(517) 676-9788

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 6801095252 MI Primary

Addresses

Primary practice location

3300 Washtenaw Ave Ste 260
Ann Arbor, MI 48104-5184

Mailing address

3300 Washtenaw Ave Ste 260
Ann Arbor, MI 48104-5184
Phone (734) 277-7565

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20131109000145 MI Part B Supplier - Clinic/Group Practice 1557596020 Receives reassigned benefits from 1 practitioner
Practice locations: Ann Arbor, MI

National Provider Directory

National Provider Directory

Locations

122 S Main St
Ste 110C
Ann Arbor, MI 48104

2500 Packard St
Ste 101A
Ann Arbor, MI 48104
Phone (734) 277-7565

3300 Washtenaw Ave
Ste 260
Ann Arbor, MI 48104
Phone (734) 276-5772

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1381795200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1628121600000",
    "number": "1598193310",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3300 WASHTENAW AVE STE 260",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481045184",
            "telephone_number": "734-277-7565",
            "fax_number": "734-215-2363"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3300 WASHTENAW AVE STE 260",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481045184",
            "telephone_number": "734-277-7565",
            "fax_number": "734-215-2363"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONNALLY COUNSELING",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-15",
        "last_updated": "2021-08-05",
        "certification_date": "2021-08-05",
        "status": "A",
        "authorized_official_last_name": "CONNALLY",
        "authorized_official_first_name": "DALTON",
        "authorized_official_middle_name": "KILLIAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "517-676-9788",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801095252",
            "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 Aug 5, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.