NPIMap

Organization Active NPI

Southfield Mental Health Associates PC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Southfield, MI
National Provider Identifier
1619015872
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
SOUTHFIELD MENTAL HEALTH ASSOCIATES PC
Practice address
17320 W 12 Mile Rd
Suite 101
Southfield, MI 48076-2102
Phone
(248) 557-3606
Fax
(248) 557-4697
NPI assigned
Feb 1, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Lawrence J Gusman, PHD
Title
Owner President
Phone
(248) 557-3606

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X Primary

Addresses

Primary practice location

17320 W 12 Mile Rd
Suite 101
Southfield, MI 48076-2102

Mailing address

17320 W 12 Mile Rd
Suite 101
Southfield, MI 48076-2102
Phone (248) 557-3606

Other identifiers 2

IdentifierTypeStateIssuer
302643OtherMIVALUE OPTIONS
7509106210OtherMIBLUE CROSS MICHIGAN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20211012002576 MI Part B Supplier - Clinic/Group Practice 9931507514 Receives reassigned benefits from 13 practitioners
Practice locations: Southfield, MI

National Provider Directory

National Provider Directory

Locations

17320 W 12 Mile Rd
Southfield, MI 48076
Phone (248) 727-3456

17320 W 12 Mile Rd
Ste 101
Southfield, MI 48076
Phone (248) 727-3456

Practitioners & affiliated clinicians

Practitioners 65

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.

View all 65

NPI Registry JSON

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

{
    "created_epoch": "1170288000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1619015872",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17320 W 12 MILE RD",
            "address_2": "SUITE 101",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480762102",
            "telephone_number": "248-557-3606",
            "fax_number": "248-557-4697"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17320 W 12 MILE RD",
            "address_2": "SUITE 101",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480762102",
            "telephone_number": "248-557-3606",
            "fax_number": "248-557-4697"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHFIELD MENTAL HEALTH ASSOCIATES PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-01",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GUSMAN",
        "authorized_official_first_name": "LAWRENCE",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER PRESIDENT",
        "authorized_official_telephone_number": "248-557-3606",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VALUE OPTIONS",
            "identifier": "302643",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS MICHIGAN",
            "identifier": "7509106210",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Southfield, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.