Justin Persoon, MA

Primary specialty

PsychologistTaxonomy code 103T00000X

License

6301015191 Issued in MI

Practice address

1686 N Lakeshore Dr
Ludington, MI 49431-9403

Phone

(231) 233-6576

Fax

(231) 845-7095

NPI assigned

Sep 5, 2012

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Lifespan Behavioral Health PLLC

  • Behavior Analyst
  • Ludington, MI
  • NPI 1275079683

  Professional

  NPD (past) Authorized official
• Northern Clinical and Diagnostic Associates, PLLC

  • Clinical Psychologist
  • Ludington, MI
  • NPI 1922282359
  NPD (past)

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

{
    "created_epoch": "1346803200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1483920000000",
    "number": "1699024745",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1686 N LAKESHORE DR",
            "city": "LUDINGTON",
            "state": "MI",
            "postal_code": "494319403",
            "telephone_number": "231-233-6576",
            "fax_number": "231-845-7095"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1686 N LAKESHORE DR",
            "city": "LUDINGTON",
            "state": "MI",
            "postal_code": "494319403",
            "telephone_number": "231-233-6576",
            "fax_number": "231-845-7095"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PERSOON",
        "first_name": "JUSTIN",
        "credential": "MA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-09-05",
        "last_updated": "2017-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "MI",
            "license": "1-16-22081",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MI",
            "license": "6401013191",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MI",
            "license": "6301015191",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Patrick Pearson
• Michelle Renee Pegg
• Pere Marquette Emergency Physicians, PLC
• Pere Marquette Medical Imaging PC
• Deanna Persoon, LMSW
• Persson Internal Medicine,P.C
• Susan Lynn Persson, PA C
• Brenden Peterson
• Carol E Peterson, M.D.
• Kaylin Petzak, PHARM.D.

• Psychologist in Ludington, MI
• Providers in Ludington, MI by specialty
• Psychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2017; 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.