Active NPI
Coletta Nelson Thomas, PSY.D, LLP
- Clinical Psychologist
- Pontiac, MI
National Provider Identifier
1972942712
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 6301014319
- Practice address
- 461 W Huron St
Pontiac, MI 48341-1601 - Phone
- (248) 465-1991
- NPI assigned
- Jun 14, 2013
- Last updated
- Jun 14, 2013
- 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 | 6301014319 | MI | Primary |
Addresses
Primary practice location
461 W Huron St
Pontiac, MI 48341-1601
Mailing address
461 W Huron St
Pontiac, MI 48341-1601
Phone (248) 465-1991
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6301014319 | MI | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fairsky Foundation | Clinical | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1371168000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1371168000000",
"number": "1972942712",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "461 W HURON ST",
"city": "PONTIAC",
"state": "MI",
"postal_code": "483411601",
"telephone_number": "248-465-1991"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "461 W HURON ST",
"city": "PONTIAC",
"state": "MI",
"postal_code": "483411601",
"telephone_number": "248-465-1991"
}
],
"practiceLocations": [],
"basic": {
"last_name": "THOMAS",
"first_name": "COLETTA",
"middle_name": "NELSON",
"credential": "PSY.D, LLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-06-14",
"last_updated": "2013-06-14",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MI",
"license": "6301014319",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pontiac, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.