Mark Brian Anderson, ED.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

6301011646 Issued in MI

Practice address

29260 Franklin Rd
Ste 110
Southfield, MI 48034-1196

Phone

(248) 722-1652

Fax

(248) 485-6798

NPI assigned

Jan 23, 2007

Last updated

Nov 6, 2017By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Anderson Center, P.C.

  dba Anderson Psychology Center

  • Psychologist
  • Southfield, MI
  • NPI 1710144050
  Medicare reassignment NPD Authorized official
• Richard Kneip, PH.D., P.C.

  dba Great Lakes Psychology Group

  • Community/Behavioral Health Agency
  • Clarkston, MI
  • NPI 1679739700
  NPD
• Wellspring Therapeutic Partners, LLC

  • Counselor
  • Clinton Township, MI
  • NPI 1801293592
  NPD (past)

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

{
    "created_epoch": "1169510400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1509926400000",
    "number": "1952455123",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29260 FRANKLIN RD",
            "address_2": "STE 110",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480341196",
            "telephone_number": "248-722-1652",
            "fax_number": "248-485-6798"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29260 FRANKLIN RD",
            "address_2": "STE 110",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480341196",
            "telephone_number": "248-722-1652",
            "fax_number": "248-485-6798"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "MARK",
        "middle_name": "BRIAN",
        "name_prefix": "Dr.",
        "credential": "ED.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-23",
        "last_updated": "2017-11-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MI",
            "license": "6301011646",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christopher Anderson, M.D.
• Jayla Anderson
• Linda Anderson
• Maiya Averi Anderson, LLPC
• Marcus Wendell Anderson
• Megan Anderson, SW
• Paul David Anderson, PH.D.
• Rachel Anne Anderson, DC, CMT
• Reconna Rochelle Anderson
• Robyn Anderson

• Psychologist in Southfield, MI
• Providers in Southfield, MI by specialty
• Psychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2017; 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.