Active NPI
Patricia Anne Haist, MA
- Clinical Psychologist
- Grand Rapids, MI
National Provider Identifier
1922279264
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 6301006609
- Practice address
- 25 Sheldon Blvd SE
Grand Rapids, MI 49503-4209 - Phone
- (616) 459-7062
- Fax
- (616) 459-0392
- NPI assigned
- Mar 14, 2008
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 6301006609 | MI | Primary |
Addresses
Primary practice location
25 Sheldon Blvd SE
Grand Rapids, MI 49503-4209
Mailing address
25 Sheldon Blvd SE
Grand Rapids, MI 49503-4209
Phone (616) 459-7062
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
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6301006609 | MI | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1205452800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1205452800000",
"number": "1922279264",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "25 SHELDON BLVD SE",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495034209",
"telephone_number": "616-459-7062",
"fax_number": "616-459-0392"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "25 SHELDON BLVD SE",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495034209",
"telephone_number": "616-459-7062",
"fax_number": "616-459-0392"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HAIST",
"first_name": "PATRICIA",
"middle_name": "ANNE",
"name_prefix": "Ms.",
"credential": "MA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-03-14",
"last_updated": "2008-03-14",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MI",
"license": "6301006609",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grand Rapids, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.