John Douglas Berridge, M.S., LLP

Individual provider Active NPI Cognitive & Behavioral Psychologist · Adrian, MI

NPI 1992946826 · NPPES record last updated Mar 24, 2009

Key facts

NPI
1992946826
Entity type
Individual (NPI type 1)
Primary specialty
Cognitive & Behavioral Psychologist 103TB0200X
License
6301007547 (MI)
Practice address
1040 S Winter St
Suite 1022
Adrian, MI 49221-3876
Phone
(517) 263-8905
Fax
(517) 265-8237
NPI assigned
Mar 24, 2009
Sex
Male
Sole proprietor
No

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
6301007547MIMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Lenawee Community Mental Health Authority Past
since Oct 1, 2001
Accepting new patients
Lenawee Community Mental Health Authority Past Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Cognitive & Behavioral Psychologist 103TB0200X 6301007547 MI Yes
Clinical Psychologist 103TC0700X 6301007547 MI

Addresses

Primary practice location

1040 S Winter St
Suite 1022
Adrian, MI 49221-3876

Mailing address

1040 S Winter St
Suite 1022
Adrian, MI 49221-3876
Phone (517) 263-8905

Other providers in Adrian, MI

All providers in Adrian, MI · Cognitive & Behavioral Psychologist in Michigan

Sources for this page

Verify at the official NPI Registry.