Spencer Manor Living Well

Primary specialty

Intellectual & Developmental Disabilities PsychologistTaxonomy code 103TM1800X

License

AS250306594 Issued in MI

Legal business name

SPENCER MANOR LIVING WELL

Practice address

2219 S Term St
Burton, MI 48519-1030

Phone

(810) 744-2777

NPI assigned

May 29, 2012

Organization subpart

No

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

Authorized official

Name

Mrs. Patricia Marie Royster

Title

Owner

Phone

(810) 744-2777

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1338249600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1338249600000",
    "number": "1750641452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2219 S TERM ST",
            "city": "BURTON",
            "state": "MI",
            "postal_code": "485191030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2219 S TERM ST",
            "city": "BURTON",
            "state": "MI",
            "postal_code": "485191030",
            "telephone_number": "810-744-2777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPENCER MANOR LIVING WELL",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-29",
        "last_updated": "2012-05-29",
        "status": "A",
        "authorized_official_last_name": "ROYSTER",
        "authorized_official_first_name": "PATRICIA",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "810-744-2777",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "103TM1800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Intellectual & Developmental Disabilities",
            "state": "MI",
            "license": "AS250306594",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Intellectual & Developmental Disabilities Psychologist in Burton, MI
• Providers in Burton, MI by specialty
• Intellectual & Developmental Disabilities Psychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 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.

Verify at the official NPI Registry.