Theresa I Egan, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

6301011944 Issued in MI

Practice address

17336 W 12 Mile Rd Ste 101
Southfield, MI 48076-2113

Phone

(586) 610-4006

NPI assigned

Sep 7, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

Practice roles

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

• Seniors Wellness Group of Michigan, P.C.

  • Clinical Psychologist
  • Royal Oak, MI
  • NPI 1801848718
  NPD (past)

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

{
    "created_epoch": "1157587200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1245801600000",
    "number": "1790888352",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17336 W 12 MILE RD STE 101",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480762113",
            "telephone_number": "586-610-4006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17336 W 12 MILE RD STE 101",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480762113",
            "telephone_number": "586-610-4006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EGAN",
        "first_name": "THERESA",
        "middle_name": "I",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-09-07",
        "last_updated": "2009-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MI",
            "license": "6301011944",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sanyani D Edwards, TLLP
• Shawn Edwards
• Wanda E Edwards, NP
• Anita Effinger, FNP
• Arthur A Efros, M.D.
• Karen E. Eggleston, D.D.S.
• Jonathan Patrick Egle, M.D.
• Brenda Ehrke
• Jeffrey Michael Eichenlaub, MSN. APRN, FNP-C
• Lawrence Mark Eilender, MD

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2009; 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.