NPIMap

Organization Active NPI

Clinton County Medical Center Psychological Services PLLC

  • Mental Health Counselor
  • Saint Johns, MI
National Provider Identifier
1871931055
Registry record updated Jul 31, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
CLINTON COUNTY MEDICAL CENTER PSYCHOLOGICAL SERVICES PLLC
Practice address
1505 Waterford Pkwy
Saint Johns, MI 48879-9630
Phone
(989) 224-3000
Fax
(989) 224-0951
NPI assigned
Jun 10, 2013
Last updated
Jul 31, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 31, 2014

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

Authorized official

Name
Mr. Brad Messenger, LLMSWNPI 1598076382
Title
Executive Director
Phone
(989) 224-3000

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X NU
Mental Health Counselor 101YM0800X NU Primary
Hearing Instrument Specialist 237700000X NU

Addresses

Primary practice location

1505 Waterford Pkwy
Saint Johns, MI 48879-9630

Mailing address

1505 Waterford Pkwy
Saint Johns, MI 48879-9630
Phone (989) 224-3000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140206000773 MI Part B Supplier - Clinic/Group Practice 4082843412 Receives reassigned benefits from 34 practitioners
1 other NPI on this enrollment
Practice locations: Alma, MI; Howell, MI; Jackson, MI; Midland, MI; Saint Johns, MI; St Johns, MI

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Clinton County Medical Center Psychological Services PLLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

323 E Grand River Ave
Howell, MI 48843
Phone (517) 273-9033

437 Fern Ave
Ste C
Jackson, MI 49202
Phone (517) 247-2033

Practitioners & affiliated clinicians

Practitioners 38

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 38

NPI Registry JSON

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

{
    "created_epoch": "1370822400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1406764800000",
    "number": "1871931055",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1505 WATERFORD PKWY",
            "city": "SAINT JOHNS",
            "state": "MI",
            "postal_code": "488799630",
            "telephone_number": "989-224-3000",
            "fax_number": "989-224-0951"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1505 WATERFORD PKWY",
            "city": "SAINT JOHNS",
            "state": "MI",
            "postal_code": "488799630",
            "telephone_number": "989-224-3000",
            "fax_number": "989-224-0951"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLINTON COUNTY MEDICAL CENTER PSYCHOLOGICAL SERVICES PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-10",
        "last_updated": "2014-07-31",
        "status": "A",
        "authorized_official_last_name": "MESSENGER",
        "authorized_official_first_name": "BRAD",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "989-224-3000",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LLMSW"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "237700000X",
            "taxonomy_group": "",
            "desc": "Hearing Instrument Specialist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Johns, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.