Jaclyn Hamlin, M.S.C.P, TLLP

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

6301016375 Issued in MI

Practice address

25501 Van Dyke Ave
Lifeline Psychiatric Services
Center Line, MI 48015-1208

Phone

(586) 755-8911

NPI assigned

Oct 26, 2015

Last updated

Oct 30, 2015By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/13320/brand/1/csg/1/fhir/r4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Life Line Psychiatric Services

  • Psychiatry Physician
  • Center Line, MI
  • NPI 1285064063
  NPD (past)

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

{
    "created_epoch": "1445817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1446163200000",
    "number": "1821460270",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "31219 ARROWHEAD ST",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480821208",
            "telephone_number": "248-275-9067"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25501 VAN DYKE AVE",
            "address_2": "LIFELINE PSYCHIATRIC SERVICES",
            "city": "CENTER LINE",
            "state": "MI",
            "postal_code": "480151208",
            "telephone_number": "586-755-8911"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAMLIN",
        "first_name": "JACLYN",
        "credential": "M.S.C.P, TLLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-10-26",
        "last_updated": "2015-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MI",
            "license": "6301016375",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PSYCHOLOGIST TEMPORARY LIMITED LICENSE",
            "identifier": "630106375",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "13642807",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Amanda Gunderson
• Michelle Habbo, LLMSW
• Julia Habel, MS, OTRL
• Matthew Joshua Hagelin
• Anglique Hairston
• Roslene Harbin
• Theresa Lynne Harpold, MD
• Janelle Catherine Harris, R.N.
• Samantha Harris
• Carrie Harvey-Grossberg, LPC

• Clinical Psychologist in Center Line, MI
• Providers in Center Line, MI by specialty
• Clinical Psychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2015; 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.