Oakland Psychological Clinic PC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

Legal business name

OAKLAND PSYCHOLOGICAL CLINIC PC

Doing business as

Oakland Psychological Clinic PC

Practice address

14165 N Fenton Rd # 201
Fenton, MI 48430-1587

Phone

(904) 605-4986

NPI assigned

Sep 8, 2023

Organization subpart

No

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

Authorized official

Name

Elliott Richelson

Title

Chief Medical Officer

Phone

(904) 456-0002

Specialties & licenses 1

Addresses

Other names 1

• Oakland Psychological Clinic PC Doing business as

Tax ID family

Oakland Psychological Clinic PC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Oakland Psychological Clinic, P.C.

  • Clinical Social Worker
  • Bloomfield Hills, MI
  • NPI 1437689312
  NPD tax ID

Locations

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

{
    "created_epoch": "1694131200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1694131200000",
    "number": "1619754157",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1090 S TAMIAMI TRL STE 1",
            "city": "SARASOTA",
            "state": "FL",
            "postal_code": "342369116",
            "telephone_number": "904-605-4986"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14165 N FENTON RD # 201",
            "city": "FENTON",
            "state": "MI",
            "postal_code": "484301587",
            "telephone_number": "904-605-4986"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OAKLAND PSYCHOLOGICAL CLINIC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-09-08",
        "last_updated": "2023-09-08",
        "certification_date": "2023-09-08",
        "status": "A",
        "authorized_official_last_name": "RICHELSON",
        "authorized_official_first_name": "ELLIOTT",
        "authorized_official_title_or_position": "CHIEF MEDICAL OFFICER",
        "authorized_official_telephone_number": "904-456-0002"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Oakland Psychological Clinic PC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Professional Counselor in Fenton, MI
• Providers in Fenton, MI by specialty
• Professional Counselor in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2023; 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.