Sean Michael Dougherty, MA LLP
Individual provider Active NPI Psychologist · Ada, MI
NPI 1902841968 · NPPES record last updated Dec 13, 2023
Key facts
- NPI
- 1902841968
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychologist 103T00000X
- License
- 6301009294 (MI)
- Practice address
- 967 Spaulding Ave SE Ste E
Ada, MI 49301-3703 - Phone
- (616) 504-1002
- Fax
- (616) 719-4480
- NPI assigned
- Jun 16, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Master of Arts
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sean Dougherty PC | Current | Accepting new patients |
Locations
967 Spaulding Ave SE
Ste E
Ada, MI 49301
Phone (616) 581-3085
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 6301009294 | MI | Yes |
Addresses
Primary practice location
967 Spaulding Ave SE Ste E
Ada, MI 49301-3703
Mailing address
967 Spaulding Ave SE Ste E
Ada, MI 49301-3703
Phone (616) 504-1002
Other providers in Ada, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 13, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.