BURDETTE AND DOSS PSYCHOLOGICAL SERVICES LC NPI 1073647731

NPI Information

NPI: 1073647731
Provider Name: BURDETTE AND DOSS PSYCHOLOGICAL SERVICES LC
Classification: Clinic/Center - 261QM0801X
Entity Type: Organization

Specialization: Mental Health (Including Community Mental Health Center)

Address:
17352 W 12 MILE RD
SUITE 100
SOUTHFIELD, MI
ZIP 48076
Phone: (248) 559-0730
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BURDETTE AND DOSS PSYCHOLOGICAL SERVICES LC is a mental health (including community mental health center) clinic center in Southfield, MI. BURDETTE AND DOSS PSYCHOLOGICAL SERVICES LC NPI is 1073647731. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

17352 W 12 MILE RD
SUITE 100
SOUTHFIELD, MI
ZIP 48076-119
Phone: (248) 559-0730
Fax: (248) 569-7626

The provider's authorized official is Barbara Ann Elisabeth Tysell .
The authorized official title is Administrative Director and has the following contact phone number (248) 559-0730.

The enumeration date for this NPI number is 3/15/2007 and was last updated on 10/28/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	101Y00000X	Counselor				No
2	101YA0400X	Counselor	Addiction (Substance Use Disorder)			No
3	101YM0800X	Counselor	Mental Health			No
4	103T00000X	Psychologist				No
5	103TC0700X	Psychologist	Clinical			No
6	103TC2200X	Psychologist	Clinical Child & Adolescent			No
7	1041C0700X	Social Worker	Clinical			No
8	106H00000X	Marriage & Family Therapist				No
9	2084P0800X	Psychiatry & Neurology	Psychiatry			No
10	261QR0405X	Clinic/Center	Rehabilitation, Substance Use Disorder	630534	MICHIGAN	No
11	103TP0814X	Psychologist	Psychoanalysis			No
12	101YP2500X	Counselor	Professional			No
13	261QM0801X	Clinic/Center	Mental Health (Including Community Mental Health Center)	630534	MICHIGAN	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	0910921	OTHER	MICHIGAN	BCBS OF MICHIGAN
2	0913921	OTHER	MICHIGAN	BCBS PROVIDER ID MASTERS
3	0F37268001	MEDICARE PIN	MICHIGAN
4	F037350	OTHER	MICHIGAN	WEB DENIS IDENTIFIER
5	7509109210	OTHER	MICHIGAN	BCBS NASCO IDENTIFIER
6	38314498	OTHER	MICHIGAN	HAP PROVIDER ID
7	0F37268013	MEDICARE PIN	MICHIGAN
8	187925000	OTHER	MICHIGAN	MAGELLAN IDENTIFIER
9	0912921	OTHER	MICHIGAN	BCBS PROVIDER ID PHDS
10	7509109210	OTHER	MICHIGAN	VALUEOPTIONS
11	10921	OTHER	MICHIGAN	BCBS MANAGED CARE CODE
12	125750	OTHER	MICHIGAN	VALUE OPTIONS PROVIDER ID
13	OM30330	MEDICARE ID-TYPE UNSPECIFIED	MICHIGAN	EDWARD ROBERTS MD AND MDS
14	0F37268015	MEDICARE PIN	MICHIGAN
15	26 0 F3 2684 0	OTHER	MICHIGAN	NASCO GROUP TRACKING ID
16	1316097488	OTHER	MICHIGAN	NPPESJAMES A. COWLEY NPI
17	P69427	OTHER	MICHIGAN	BLUE CARE NETWORK PIN
18	0911921	OTHER	MICHIGAN	BCBS PROVIDER ID MDS
19	F43390	MEDICARE UPIN	MICHIGAN
20	0F37268008	MEDICARE PIN	MICHIGAN
21	750910921	OTHER	MICHIGAN	BCBS TRADITIONAL CODE
22	630534	OTHER	MICHIGAN	STATE SUBSTANCE ABUSE LIC
23	20700	OTHER	MICHIGAN	BCBS SUB AB AND MGD CARE
24	0F37268014	MEDICARE PIN	MICHIGAN
25	0F37268	MEDICARE PIN	MICHIGAN
26	0M67590	MEDICARE ID-TYPE UNSPECIFIED	MICHIGAN	JAMES COWLEY LSW MASTERS
27	0F37268011	MEDICARE PIN	MICHIGAN
28	0F37268012	MEDICARE PIN	MICHIGAN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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