Active NPI
Christine Jo Hergren, MA, LLP, CAAC
- Psychologist
- Southgate, MI
National Provider Identifier
1891981775
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 6301013667
- Practice address
- 15306 Helen St
Southgate, MI 48195-2068 - Phone
- (313) 475-8888
- NPI assigned
- Sep 24, 2007
- 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | 6301013667 | MI | Primary |
Addresses
Primary practice location
15306 Helen St
Southgate, MI 48195-2068
Mailing address
15306 Helen St
Southgate, MI 48195-2068
Phone (313) 475-8888
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)
- Enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6301013667 | MI | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1190592000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1267056000000",
"number": "1891981775",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15306 HELEN ST",
"city": "SOUTHGATE",
"state": "MI",
"postal_code": "481952068",
"telephone_number": "313-475-8888"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15306 HELEN ST",
"city": "SOUTHGATE",
"state": "MI",
"postal_code": "481952068",
"telephone_number": "313-475-8888"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HERGREN",
"first_name": "CHRISTINE",
"middle_name": "JO",
"name_prefix": "Ms.",
"credential": "MA, LLP, CAAC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-09-24",
"last_updated": "2010-02-25",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MI",
"license": "6301013667",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Southgate, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.