Active NPI
Malissa Wood, MA, LLP, LPC
- Professional Counselor
- Shelby Township, MI
National Provider Identifier
1700979838
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 6401006969
- Practice address
- 14067 Lakeside Blvd N
Shelby Township, MI 48315-6074 - Phone
- (586) 255-2482
- NPI assigned
- Oct 2, 2006
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 6401006969 | MI | Primary |
| Counseling Psychologist | 103TC1900X | 630101724 | MI |
Addresses
Primary practice location
14067 Lakeside Blvd N
Shelby Township, MI 48315-6074
Mailing address
18964 Strongford Dr
Macomb, MI 48044-9700
Phone (586) 255-2482
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
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6401006969 | MI | MD | Professional Counselor |
| 630101724 | MI | MD | Counseling Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159747200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1341446400000",
"number": "1700979838",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "18964 STRONGFORD DR",
"city": "MACOMB",
"state": "MI",
"postal_code": "480449700",
"telephone_number": "586-255-2482"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14067 LAKESIDE BLVD N",
"city": "SHELBY TOWNSHIP",
"state": "MI",
"postal_code": "483156074",
"telephone_number": "586-255-2482"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WOOD",
"first_name": "MALISSA",
"credential": "MA, LLP, LPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-10-02",
"last_updated": "2012-07-05",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "MI",
"license": "6401006969",
"primary": true
},
{
"code": "103TC1900X",
"taxonomy_group": "",
"desc": "Psychologist, Counseling",
"state": "MI",
"license": "630101724",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Shelby Township, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.