Interface I PC

Primary specialty

Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X

License

6301007437 Issued in MI

Legal business name

INTERFACE I PC

Practice address

4170 Pontiac Lake Rd
Waterford, MI 48328-1282

Phone

(248) 674-2659

Fax

(248) 674-2659

NPI assigned

Mar 22, 2007

Organization subpart

No

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

Authorized official

Name

Patricia Armstrong, PH.D.

Title

Owner

Phone

(248) 674-2659

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1174521600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1210723200000",
    "number": "1801912753",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4170 PONTIAC LAKE RD",
            "city": "WATERFORD",
            "state": "MI",
            "postal_code": "483281282",
            "telephone_number": "248-674-2659",
            "fax_number": "248-674-2659"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4170 PONTIAC LAKE RD",
            "city": "WATERFORD",
            "state": "MI",
            "postal_code": "483281282",
            "telephone_number": "248-674-2659",
            "fax_number": "248-674-2659"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERFACE I PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-22",
        "last_updated": "2008-05-14",
        "status": "A",
        "authorized_official_last_name": "ARMSTRONG",
        "authorized_official_first_name": "PATRICIA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "248-674-2659",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "MI",
            "license": "6301007437",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM",
            "identifier": "680F330170",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Clinical Child & Adolescent Psychologist in Waterford, MI
• Providers in Waterford, MI by specialty
• Clinical Child & Adolescent Psychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2008; 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.