Debbie Koeltzow, EDD, LP

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

6301011430 Issued in MI

Practice address

810 E Grand River Ave
#101
Brighton, MI 48116-1878

Phone

(810) 588-4236

Fax

(810) 588-4247

NPI assigned

Jul 10, 2007

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 4

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2000

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Mindful Living PLLCGroup PAC ID 6709914690, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Mindful Living PLLC

  • Psychologist
  • Brighton, MI
  • NPI 1013145879
  Medicare reassignment Care Compare group NPD Authorized official

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

{
    "created_epoch": "1184025600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1240790400000",
    "number": "1902004070",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2460 CARRIAGE WAY",
            "city": "YPSILANTI",
            "state": "MI",
            "postal_code": "481977423",
            "telephone_number": "734-657-8059",
            "fax_number": "810-588-4247"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "810 E GRAND RIVER AVE",
            "address_2": "#101",
            "city": "BRIGHTON",
            "state": "MI",
            "postal_code": "481161878",
            "telephone_number": "810-588-4236",
            "fax_number": "810-588-4247"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOELTZOW",
        "first_name": "DEBBIE",
        "name_prefix": "Dr.",
        "credential": "EDD, LP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-07-10",
        "last_updated": "2009-04-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MI",
            "license": "6301011430",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BC OF MICHIGAN",
            "identifier": "68OH113370",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VALUE OPTIONS",
            "identifier": "143449",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PPOM",
            "identifier": "382695674",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA BEHAVIORAL HEALTH",
            "identifier": "382695674",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Melanie Klenk, CNP
• Lisa Marie Klink, R.N.
• Roberta Ann Knittle, PA-C
• June Ko
• Ellen I Koch, PHD
• Carly Komaromi
• Jacqueline Lee Konley, LMSW
• Kor Chiro Studio PLLC (Kor Chiro Studio)
• Siddhika B Kore, PT
• Rebecca Moolayil Korpal, DO

• Clinical Psychologist in Brighton, MI
• Providers in Brighton, MI by specialty
• Clinical Psychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.