Active NPI
Donovan Bennett
- Clinical Psychologist
- Grand Blanc, MI
National Provider Identifier
1689446882
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 6362009852
- Practice address
- 10683 S Saginaw St Ste B
Grand Blanc, MI 48439-8127 - Phone
- (810) 771-4074
- NPI assigned
- Oct 23, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 6362009852 | MI | |
| Clinical Psychologist | 103TC0700X | 6362009852 | MI | Primary |
Addresses
Primary practice location
10683 S Saginaw St Ste B
Grand Blanc, MI 48439-8127
Mailing address
10683 S Saginaw St Ste B
Grand Blanc, MI 48439-8127
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6362009852 | MI | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1698019200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1698019200000",
"number": "1689446882",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10683 S SAGINAW ST STE B",
"city": "GRAND BLANC",
"state": "MI",
"postal_code": "484398127"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10683 S SAGINAW ST STE B",
"city": "GRAND BLANC",
"state": "MI",
"postal_code": "484398127",
"telephone_number": "810-771-4074"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BENNETT",
"first_name": "DONOVAN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-10-23",
"last_updated": "2023-10-23",
"certification_date": "2023-10-23",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MI",
"license": "6362009852",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MI",
"license": "6362009852",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grand Blanc, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 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.