NPIMap

Organization Active NPI

Old Town Psychological Services-Gaylord

  • Clinical Child & Adolescent Psychologist
  • Gaylord, MI
National Provider Identifier
1750659249
Registry record updated Dec 12, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X
Legal business name
OLD TOWN PSYCHOLOGICAL SERVICES-GAYLORD
Practice address
128 N Court Ave
Gaylord, MI 49735-1408
Phone
(989) 448-8344
NPI assigned
Dec 12, 2011
Organization subpart
Yes
Parent organization
OLD TOWN PSYCHOLOGICAL SERVICESAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 12, 2011

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

Authorized official

Name
Dr. Michael P Hayes, PH.D.NPI 1528106606
Title
Ceo
Phone
(989) 448-8344

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
Clinical Child & Adolescent PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC2200X Primary

Addresses

Primary practice location

128 N Court Ave
Gaylord, MI 49735-1408

Mailing address

512 S Union St
Traverse City, MI 49684-3247
Phone (231) 941-6550

National Provider Directory

National Provider Directory
Tax ID family
Old Town Psychological2 organizations share this tax ID, including this one
Part of
Old Town Psychological

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 33

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

View all 33

NPI Registry JSON

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

{
    "created_epoch": "1323648000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1323648000000",
    "number": "1750659249",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "512 S UNION ST",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496843247",
            "telephone_number": "231-941-6550",
            "fax_number": "231-941-8981"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "128 N COURT AVE",
            "city": "GAYLORD",
            "state": "MI",
            "postal_code": "497351408",
            "telephone_number": "989-448-8344"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OLD TOWN PSYCHOLOGICAL SERVICES-GAYLORD",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "OLD TOWN PSYCHOLOGICAL SERVICES",
        "enumeration_date": "2011-12-12",
        "last_updated": "2011-12-12",
        "status": "A",
        "authorized_official_last_name": "HAYES",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "989-448-8344",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gaylord, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2011; 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.