Individual provider Active NPI

Ann Marie Liesen, LPC

  • Professional Counselor
  • Clinton Township, MI
National Provider Identifier
1790926657
Registry record updated Oct 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
6401010129 Issued in MI
Practice address
15600 19 Mile Rd
Clinton Township, MI 48038-3502
Phone
(586) 263-8700
Fax
(248) 475-6402
NPI assigned
Mar 23, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 29, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X 6401010129 MI Primary
Social Worker 104100000X 6802073882 MI

Addresses

Primary practice location

15600 19 Mile Rd
Clinton Township, MI 48038-3502

Mailing address

2399 E Walton Blvd
Auburn Hills, MI 48326-1955
Phone (248) 475-6300

Other practice location 1

5111 Auto Club Dr
Dearborn, MI 48126-2749
Phone (248) 536-5085

Other practice location 2

6770 Dixie Hwy Ste 200
Clarkston, MI 48346-5113
Phone (248) 276-8000

Other practice location 3

2399 E Walton Blvd
Auburn Hills, MI 48326-1955
Phone (248) 475-6300

Other practice location 4

1270 Doris Rd
Auburn Hills, MI 48326-2617
Phone (586) 854-1813

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241017000758 MI Practitioner - Mental Health Counselor 8426580259 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Easterseals Morc Health Care, IncGroup PAC ID 9830141670, 129 clinicians

Practice addresses (Care Compare)

2399 E Walton Blvd
Auburn Hills, MI 48326-1955
Phone (248) 475-6300

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6802073882MIMDSocial Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Easterseals Morc Health Care, Inc. CurrentSince Jul 22, 2024 Accepting new patients

Locations

2399 E Walton Blvd
Auburn Hills, MI 48326
Phone (248) 475-6400

6770 Dixie Hwy
Ste 200
Clarkston, MI 48346
Phone (248) 625-2273

15600 19 Mile Rd
Clinton Twp, MI 48038
Phone (586) 263-8735

22170 W 9 Mile Rd
Southfield, MI 48033
Phone (248) 357-8197

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1237766400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730160000000",
    "number": "1790926657",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2399 E WALTON BLVD",
            "city": "AUBURN HILLS",
            "state": "MI",
            "postal_code": "483261955",
            "telephone_number": "248-475-6300",
            "fax_number": "248-475-6402"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15600 19 MILE RD",
            "city": "CLINTON TOWNSHIP",
            "state": "MI",
            "postal_code": "480383502",
            "telephone_number": "586-263-8700",
            "fax_number": "248-475-6402"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5111 Auto Club Dr",
            "address_purpose": "LOCATION",
            "city": "Dearborn",
            "state": "MI",
            "postal_code": "481262749",
            "country_code": "US",
            "telephone_number": "248-536-5085",
            "fax_number": "248-475-6402",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6770 Dixie Hwy Ste 200",
            "address_purpose": "LOCATION",
            "city": "Clarkston",
            "state": "MI",
            "postal_code": "483465113",
            "country_code": "US",
            "telephone_number": "248-276-8000",
            "fax_number": "248-475-6402",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2399 E Walton Blvd",
            "address_purpose": "LOCATION",
            "city": "Auburn Hills",
            "state": "MI",
            "postal_code": "483261955",
            "country_code": "US",
            "telephone_number": "248-475-6300",
            "fax_number": "248-475-6402",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1270 Doris Rd",
            "address_purpose": "LOCATION",
            "city": "Auburn Hills",
            "state": "MI",
            "postal_code": "483262617",
            "country_code": "US",
            "telephone_number": "586-854-1813",
            "fax_number": "248-276-9208",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LIESEN",
        "first_name": "ANN",
        "middle_name": "MARIE",
        "name_prefix": "Ms.",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-03-23",
        "last_updated": "2024-10-29",
        "certification_date": "2024-10-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MI",
            "license": "6401010129",
            "primary": true
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MI",
            "license": "6802073882",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clinton Township, MI

Sources for this page

Verify at the official NPI Registry.