NPIMap

Organization Active NPI

Anderson Center, P.C.

Doing business as Anderson Psychology Center

  • Psychologist
  • Southfield, MI
National Provider Identifier
1710144050
Registry record updated May 22, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
6301011646 Issued in MI
Legal business name
ANDERSON CENTER, P.C.
Doing business as
Anderson Psychology Center
Practice address
29260 Franklin Rd
Suite 110
Southfield, MI 48034-1161
Phone
(248) 352-0012
Fax
(248) 352-0013
NPI assigned
May 22, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 22, 2008

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

Authorized official

Name
Dr. Mark Brian Anderson, ED.D.NPI 1952455123
Title
Licensed Psychologist
Phone
(248) 352-0012

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103T00000X 6301011646 MI Primary

Addresses

Primary practice location

29260 Franklin Rd
Suite 110
Southfield, MI 48034-1161

Mailing address

29260 Franklin Rd
Suite 110
Southfield, MI 48034-1161
Phone (248) 352-0012

Other names 1

  • Anderson Psychology Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040618000049 MI Part B Supplier - Clinic/Group Practice 5597749267 Receives reassigned benefits from 2 practitioners
Practice locations: Southfield, MI

National Provider Directory

National Provider Directory

Locations

29260 Franklin Rd
Ste 110
Southfield, MI 48034
Phone (248) 722-1652

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1211414400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1211414400000",
    "number": "1710144050",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29260 FRANKLIN RD",
            "address_2": "SUITE 110",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480341161",
            "telephone_number": "248-352-0012",
            "fax_number": "248-352-0013"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29260 FRANKLIN RD",
            "address_2": "SUITE 110",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480341161",
            "telephone_number": "248-352-0012",
            "fax_number": "248-352-0013"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANDERSON CENTER, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-22",
        "last_updated": "2008-05-22",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "BRIAN",
        "authorized_official_title_or_position": "LICENSED PSYCHOLOGIST",
        "authorized_official_telephone_number": "248-352-0012",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "ED.D."
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": "MI",
            "license": "6301011646",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Anderson Psychology Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Southfield, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.