Active NPI
Maryann Frederick, PH.D.
- Professional Counselor
- Midland, MI
National Provider Identifier
1790901759
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 6401005947
- Practice address
- 1813 Candlestick LN
Midland, MI 48642-3116 - Phone
- (989) 832-3665
- Fax
- (989) 832-3665
- NPI assigned
- Apr 18, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 6401005947 | MI | Primary |
Addresses
Primary practice location
1813 Candlestick LN
Midland, MI 48642-3116
Mailing address
1813 Candlestick LN
Midland, MI 48642-3116
Phone (989) 832-3665
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 11694289 | Other | MI | CAQH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6401005947 | MI | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176854400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1790901759",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1813 CANDLESTICK LN",
"city": "MIDLAND",
"state": "MI",
"postal_code": "486423116",
"telephone_number": "989-832-3665",
"fax_number": "989-832-3665"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1813 CANDLESTICK LN",
"city": "MIDLAND",
"state": "MI",
"postal_code": "486423116",
"telephone_number": "989-832-3665",
"fax_number": "989-832-3665"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FREDERICK",
"first_name": "MARYANN",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-04-18",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "MI",
"license": "6401005947",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAQH",
"identifier": "11694289",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Midland, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.