Active NPI
Rex R Skupien, TLLP
- Psychologist
- White Cloud, MI
National Provider Identifier
1912359043
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 6301016756
- Practice address
- 1035 E Wilcox Ave
White Cloud, MI 49349-8794 - Phone
- (231) 689-5943
- Fax
- (231) 689-1590
- NPI assigned
- Jul 13, 2016
- Sex
- Male
- 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 | 6301016756 | MI | Primary |
Addresses
Primary practice location
1035 E Wilcox Ave
White Cloud, MI 49349-8794
Mailing address
1615 Michigan Ave
Baldwin, MI 49304-7984
Phone (231) 745-5045
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6301016756 | MI | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1468368000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1468368000000",
"number": "1912359043",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1615 MICHIGAN AVE",
"city": "BALDWIN",
"state": "MI",
"postal_code": "493047984",
"telephone_number": "231-745-5045",
"fax_number": "231-745-5031"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1035 E WILCOX AVE",
"city": "WHITE CLOUD",
"state": "MI",
"postal_code": "493498794",
"telephone_number": "231-689-5943",
"fax_number": "231-689-1590"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SKUPIEN",
"first_name": "REX",
"middle_name": "R",
"credential": "TLLP",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-07-13",
"last_updated": "2016-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MI",
"license": "6301016756",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in White Cloud, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.