Psychological Assessment & Counselingspecialists of South Central Mich

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

6301015040 Issued in MI

Legal business name

PSYCHOLOGICAL ASSESSMENT & COUNSELINGSPECIALISTS OF SOUTH CENTRAL MICH

Practice address

28 W Chicago St
Suite 3G
Coldwater, MI 49036-1677

Phone

(517) 677-9224

NPI assigned

Jun 24, 2016

Organization subpart

No

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

Authorized official

Name

Shawn Talbot, PHD

Title

Sole Member

Phone

(517) 677-9224

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1466726400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1466726400000",
    "number": "1831540525",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1131 N OSSEO RD",
            "city": "HILLSDALE",
            "state": "MI",
            "postal_code": "492429714",
            "telephone_number": "517-523-3695",
            "fax_number": "517-523-3311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28 W CHICAGO ST",
            "address_2": "SUITE 3G",
            "city": "COLDWATER",
            "state": "MI",
            "postal_code": "490361677",
            "telephone_number": "517-677-9224"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PSYCHOLOGICAL ASSESSMENT & COUNSELINGSPECIALISTS OF SOUTH CENTRAL MICH",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-24",
        "last_updated": "2016-06-24",
        "status": "A",
        "authorized_official_last_name": "TALBOT",
        "authorized_official_first_name": "SHAWN",
        "authorized_official_title_or_position": "SOLE MEMBER",
        "authorized_official_telephone_number": "517-677-9224",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "MI",
            "license": "6301015040",
            "primary": true
        },
        {
            "code": "103TF0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Forensic",
            "state": "MI",
            "license": "6301015040",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2016; 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.