John David Canine, EDD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

6361001384 Issued in MI

Practice address

936 S Baldwin Rd
102
Clarkston, MI 48348-3695

Phone

(248) 814-0706

Fax

(248) 814-0710

NPI assigned

Nov 7, 2008

Last updated

May 13, 2020By the provider in NPPES

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)

Not enrolled

State licenses

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

{
    "created_epoch": "1226016000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1589328000000",
    "number": "1740434471",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "936 S BALDWIN RD",
            "address_2": "102",
            "city": "CLARKSTON",
            "state": "MI",
            "postal_code": "483483695",
            "telephone_number": "248-814-0706",
            "fax_number": "248-814-0710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "936 S BALDWIN RD",
            "address_2": "102",
            "city": "CLARKSTON",
            "state": "MI",
            "postal_code": "483483695",
            "telephone_number": "248-814-0706",
            "fax_number": "248-814-0710"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CANINE",
        "first_name": "JOHN",
        "middle_name": "DAVID",
        "name_prefix": "Dr.",
        "credential": "EDD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-11-07",
        "last_updated": "2020-05-13",
        "certification_date": "2020-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MI",
            "license": "6361001384",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MI",
            "license": "6361001384",
            "primary": true
        },
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christina L. Campbell, D.O.
• Hannah Mackenzie Campbell
• Melissa Campbell, DPT
• Sally Anne Campbell
• Nan O Campione, LMSW
• Allison Canzano, BT
• Junaleth Chiong Carlson, BCBA
• Jennifer M Carr, PHARM D.
• Jillian Sara-Rataj Carr, PT
• Alexis R Carriger, MPH. RD.

• Clinical Psychologist in Clarkston, MI
• Providers in Clarkston, MI by specialty
• Clinical Psychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2020; 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.