Great Lakes Comprehensive Psychological Services

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

GREAT LAKES COMPREHENSIVE PSYCHOLOGICAL SERVICES

Practice address

1200 N West Ave Ste 812
Jackson, MI 49202-2180

Phone

(517) 783-4418

Fax

(517) 783-4504

NPI assigned

Feb 3, 2020

Organization subpart

No

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

Authorized official

Name

Marhta Catherine Kelley, CSW

Title

Owner

Phone

(517) 783-4418

Specialties & licenses 2

Addresses

Locations

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

{
    "created_epoch": "1580688000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1580688000000",
    "number": "1992336457",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 N WEST AVE STE 812",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "492022180",
            "telephone_number": "517-783-4418",
            "fax_number": "517-783-4504"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 N WEST AVE STE 812",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "492022180",
            "telephone_number": "517-783-4418",
            "fax_number": "517-783-4504"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES COMPREHENSIVE PSYCHOLOGICAL SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-02-03",
        "last_updated": "2020-02-03",
        "certification_date": "2020-02-03",
        "status": "A",
        "authorized_official_last_name": "KELLEY",
        "authorized_official_first_name": "MARHTA CATHERINE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "517-783-4418",
        "authorized_official_credential": "CSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in Jackson, MI
• Providers in Jackson, MI by specialty
• Clinical Social Worker in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.