Active NPI
Lisa Marie Provost, MA, LLP
- Clinical Psychologist
- Flint, MI
National Provider Identifier
1861575508
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 6301010883
- Practice address
- 2360 S Linden Rd
Suite 300
Flint, MI 48532-5420 - Phone
- (810) 732-0560
- Fax
- (810) 732-6351
- NPI assigned
- Oct 24, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 6301010883 | MI | Primary |
Addresses
Primary practice location
2360 S Linden Rd
Suite 300
Flint, MI 48532-5420
Mailing address
2420 Darwin LN
Saginaw, MI 48603-3456
Phone (810) 892-0784
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6301010883 | MI | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Oakland Psychological Clinic, P.C. | Clinical | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Clinical Social Worker
- Lansing, MI
- NPI 1538810080
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161648000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1861575508",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2420 DARWIN LN",
"city": "SAGINAW",
"state": "MI",
"postal_code": "486033456",
"telephone_number": "810-892-0784"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2360 S LINDEN RD",
"address_2": "SUITE 300",
"city": "FLINT",
"state": "MI",
"postal_code": "485325420",
"telephone_number": "810-732-0560",
"fax_number": "810-732-6351"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PROVOST",
"first_name": "LISA",
"middle_name": "MARIE",
"credential": "MA, LLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-24",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MI",
"license": "6301010883",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Flint, MI
Sources for this page
- 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.