Regents of the University of Michigan
Organization Active NPI Clinical Psychologist · Brighton, MI
NPI 1669728093 · NPPES record last updated Apr 30, 2021
Key facts
- NPI
- 1669728093
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinical Psychologist 103TC0700X
- Legal business name
- REGENTS OF THE UNIVERSITY OF MICHIGAN
- Practice address
- 8001 Challis Road
Brighton, MI 48116-7446 - Phone
- (810) 227-9510
- NPI assigned
- Aug 3, 2012
- Organization subpart
- Yes
- Parent organization (as reported)
- REGENTS OF THE UNIVERSITY OF MICHIGAN
Authorized official
- Name
- David Christopher Miller, MD
- Title
- President
- Phone
- (734) 936-3568
Other NPIs on the same Medicare enrollment 4
Corporate family (same tax ID) 24
Practitioners 2
-
Blake M Lancaster, PHD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031121000371 | MI | Part B Supplier - Clinic/Group Practice | 3779496856 |
Receives reassigned benefits from 507 practitioners 5 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Canton, MI; Chelsea, MI; Dexter, MI; Howell, MI; Lansing, MI; Livonia, MI; Midland, MI; Muskegon, MI… |
National Provider Directory
- Tax ID family
- Regents of Univ of Michigan
- Part of
- Regents of Univ of Michigan
Locations
3621 S State St
#700
Ann Arbor, MI 48108
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Neuropsychologist |
103G00000X | MI | ||
| Psychologist |
103T00000X | MI | ||
| Addiction (Substance Use Disorder) Psychologist |
103TA0400X | |||
| Adult Development & Aging Psychologist |
103TA0700X | MI | ||
| Cognitive & Behavioral Psychologist |
103TB0200X | MI | ||
| Clinical Psychologist |
103TC0700X | MI | Yes | |
| Counseling Psychologist |
103TC1900X | MI | ||
| Clinical Child & Adolescent Psychologist |
103TC2200X | MI | ||
| Family Psychologist |
103TF0000X | MI | ||
| Health Service Psychologist |
103TH0100X | MI | ||
| Intellectual & Developmental Disabilities Psychologist |
103TM1800X | MI | ||
| Group Psychotherapy Psychologist |
103TP2701X | MI |
Addresses
Primary practice location
8001 Challis Road
Brighton, MI 48116-7446
Mailing address
3621 S State St
Provider Enrollment
Ann Arbor, MI 48108-1633
Phone (734) 647-5299
Other providers in Brighton, MI
- Regents of the University of Michigan
- Regents of the University of Michigan
- Regents of the University of Michigan
- Regents of the University of Michigan
- Regents of the University of Michigan
- Regents of the University of Michigan
- Regents of the University of Michigan
- Regents of the University of Michigan
- Regents of the University of Michigan
- Regents of the University of Michigan
All providers in Brighton, MI · Clinical Psychologist in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 30, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.