NPIMap

Organization Active NPI

Michigan Psychological, P.C.

  • Clinical Psychologist
  • Saint Clair Shores, MI
National Provider Identifier
1801102744
Registry record updated Feb 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
6301014162 Issued in MI
Legal business name
MICHIGAN PSYCHOLOGICAL, P.C.
Practice address
29750 Harper Ave
Saint Clair Shores, MI 48082-2607
Phone
(586) 777-3200
Fax
(586) 777-7855
NPI assigned
Aug 30, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 23, 2021

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

Authorized official

Name
Dr. Paul D Ward, PH.D.NPI 1225294200
Title
Clinical Psychologist/President
Phone
(586) 777-2300

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 PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103TC0700X 6301014162 MI Primary

Addresses

Primary practice location

29750 Harper Ave
Saint Clair Shores, MI 48082-2607

Mailing address

29750 Harper Ave
Saint Clair Shores, MI 48082-2607
Phone (586) 777-3200

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200113001497 MI Part B Supplier - Clinic/Group Practice 3274968672 Receives reassigned benefits from 21 practitioners
Practice locations: Saint Clair Shores, MI

National Provider Directory

National Provider Directory

Locations

27941 Harper Ave
Ste 105
Saint Clair Shores, MI 48081
Phone (586) 777-3200

48673 Hayes Rd
Shelby Township, MI 48315
Phone (586) 745-9020

Practitioners & affiliated clinicians

Practitioners 26

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

View all 26

NPI Registry JSON

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

{
    "created_epoch": "1283126400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1614038400000",
    "number": "1801102744",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29750 HARPER AVE",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480822607",
            "telephone_number": "586-777-3200",
            "fax_number": "586-777-7855"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29750 HARPER AVE",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480822607",
            "telephone_number": "586-777-3200",
            "fax_number": "586-777-7855"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHIGAN PSYCHOLOGICAL, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-30",
        "last_updated": "2021-02-23",
        "certification_date": "2021-02-23",
        "status": "A",
        "authorized_official_last_name": "WARD",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "CLINICAL PSYCHOLOGIST/PRESIDENT",
        "authorized_official_telephone_number": "586-777-2300",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "MI",
            "license": "6301014162",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Clair Shores, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.