Gale Sandra Hackworth, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

6301018315 Issued in MI

Practice address

811 Ship St Ste 4B
Saint Joseph, MI 49085-1171

Phone

(269) 985-3618

Fax

(269) 609-6009

NPI assigned

Feb 11, 2020

Last updated

Jan 19, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2001

Medicare assignment

May accept Medicare assignment

Group practices

Lighthouse Behavioral Health PLLCGroup PAC ID 7214249739, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

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

• Lighthouse Behavioral Health, PLLC

  • Counseling Psychologist
  • Saint Joseph, MI
  • NPI 1699155226
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1581379200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611014400000",
    "number": "1710519376",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "811 SHIP ST STE 4B",
            "city": "SAINT JOSEPH",
            "state": "MI",
            "postal_code": "490851171",
            "telephone_number": "269-985-3618",
            "fax_number": "269-609-6009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "811 SHIP ST STE 4B",
            "city": "SAINT JOSEPH",
            "state": "MI",
            "postal_code": "490851171",
            "telephone_number": "269-985-3618",
            "fax_number": "269-609-6009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HACKWORTH",
        "first_name": "GALE",
        "middle_name": "SANDRA",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-02-11",
        "last_updated": "2021-01-19",
        "certification_date": "2021-01-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MI",
            "license": "6301018315",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MI",
            "license": "6301018315",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP NPI FOR LIGHTHOUSE BEHAVIORAL HEALTH",
            "identifier": "1699155226",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Meghan Guntz, LMSW
• Alexander Gutfraynd, D.O.
• Dominique Jay Gutierrez, MD
• Hackett Chiropractic, LLC
• Bruce Patrick Hackworth, PHD
• David Haddad, DDS
• Bailey Hadlich, MD
• Madison Hadlich, MD
• Deborah Kaye Hagey, OTR/L/MHS
• Richard Carl Hake, DDS

• Clinical Psychologist in Saint Joseph, MI
• Providers in Saint Joseph, MI by specialty
• Clinical Psychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.