Active NPI
Krista Marie Clancy
- Clinical Psychologist
- Novi, MI
National Provider Identifier
1992039804
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 6301011361
- Practice address
- 41935 12 Mile Rd.
Chrildren'S Hospital of Mi Autism Center
Novi, MI 48377 - Phone
- (248) 305-6211
- NPI assigned
- Sep 24, 2009
- 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 | 6301011361 | MI | Primary |
Addresses
Primary practice location
41935 12 Mile Rd.
Chrildren'S Hospital of Mi Autism Center
Novi, MI 48377
Mailing address
4201 St. Antoine Uhc 6F Mailbox# 226
University Pediatricians
Detroit, MI 48201
Phone (313) 966-5051
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 |
|---|---|---|---|
| 6301011361 | MI | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1253750400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1413504000000",
"number": "1992039804",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4201 ST. ANTOINE UHC 6F MAILBOX# 226",
"address_2": "UNIVERSITY PEDIATRICIANS",
"city": "DETROIT",
"state": "MI",
"postal_code": "48201",
"telephone_number": "313-966-5051"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "41935 12 MILE RD.",
"address_2": "CHRILDREN'S HOSPITAL OF MI AUTISM CENTER",
"city": "NOVI",
"state": "MI",
"postal_code": "48377",
"telephone_number": "248-305-6211"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLANCY",
"first_name": "KRISTA",
"middle_name": "MARIE",
"name_prefix": "Ms.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-09-24",
"last_updated": "2014-10-17",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MI",
"license": "6301011361",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Novi, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.