NPIMap

Organization Active NPI

Therapeutics, LLC

  • Methadone Clinic
  • Walled Lake, MI
National Provider Identifier
1902284193
Registry record updated Apr 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Methadone ClinicTaxonomy code 261QM2800X
License
SA0631371 Issued in MI
Legal business name
THERAPEUTICS, LLC
Practice address
1010 E West Maple Rd Ste 200
Walled Lake, MI 48390-3571
Phone
(248) 970-1602
Fax
(734) 384-3222
NPI assigned
May 8, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 29, 2024

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

Authorized official

Name
Mrs. Deidre Vian Goldsmith, CRNANPI 1578569133
Title
Program Director
Phone
(248) 525-6832

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 5

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YA0400X
Community/Behavioral Health Agency 251S00000X
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X
Methadone Clinic 261QM2800X SA0631371 MI Primary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X

Addresses

Primary practice location

1010 E West Maple Rd Ste 200
Walled Lake, MI 48390-3571

Mailing address

1010 E West Maple Rd Ste 200
Walled Lake, MI 48390-3571
Phone (248) 970-1602

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Opioid treatment program
Medicare-enrolled since May 5, 2020

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200612002446 MI Part B Supplier - Opioid Treatment Program (Otp) 7618399098 Practice locations: Walled Lake, MI

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
23D2083513Therapeutics1010 E West Maple Road Suite 200, Walled Lake, MI 48390Certificate of waiverSep 7, 2026

National Provider Directory

National Provider Directory

Locations

1010 E West Maple Rd
#200
Walled Lake, MI 48390
Phone (248) 252-6832

50222 Dennis Ct
Wixom, MI 48393
Phone (248) 525-6832

Practitioners & affiliated clinicians

Practitioners 16

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1431043200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714348800000",
    "number": "1902284193",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1010 E WEST MAPLE RD STE 200",
            "city": "WALLED LAKE",
            "state": "MI",
            "postal_code": "483903571",
            "telephone_number": "248-970-1602",
            "fax_number": "734-384-3222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1010 E WEST MAPLE RD STE 200",
            "city": "WALLED LAKE",
            "state": "MI",
            "postal_code": "483903571",
            "telephone_number": "248-970-1602",
            "fax_number": "734-384-3222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THERAPEUTICS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-08",
        "last_updated": "2024-04-29",
        "certification_date": "2024-04-29",
        "status": "A",
        "authorized_official_last_name": "GOLDSMITH",
        "authorized_official_first_name": "DEIDRE",
        "authorized_official_middle_name": "VIAN",
        "authorized_official_title_or_position": "PROGRAM DIRECTOR",
        "authorized_official_telephone_number": "248-525-6832",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "CRNA"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM2800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Methadone",
            "state": "MI",
            "license": "SA0631371",
            "primary": true
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Walled Lake, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.