Gordon E. Mackinnon, PH. D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

6301006861 Issued in MI

Practice address

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

Phone

(248) 583-9362

Fax

(248) 879-6774

NPI assigned

Oct 12, 2006

Sex

Male

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

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

Specialty

Clinical Psychologist

Education

Other, 1997

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

United Psychological Services IncGroup PAC ID 8921197807, 5 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

Practice roles

Locations

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.

• United Psychological Services Inc

  • Clinical Neuropsychologist
  • Shelby TWP, MI
  • NPI 1407947658
  Medicare reassignment Care Compare group NPD
• Clementine Counseling

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Shelby TWP, MI
  • NPI 1265360739
  NPD (past)

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

{
    "created_epoch": "1160611200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1811086697",
    "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": "248-583-9362",
            "fax_number": "248-879-6774"
        },
        {
            "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": "248-583-9362",
            "fax_number": "248-879-6774"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACKINNON",
        "first_name": "GORDON",
        "middle_name": "E.",
        "name_prefix": "Dr.",
        "credential": "PH. D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-12",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MI",
            "license": "6301006861",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Desmond Mack
• Kamryn Alice Mack, PA-C
• Levi Mack
• Tyler Mackie
• Lori Mackillop, N.P.
• Seth Macomber
• Rachel Alexandra Macpherson, TLLP
• Amita Madan, DNP, PMHNP-BC
• Kaley Madden
• Aaron W Maddox, M.D.

• 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 Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.