MICHIGAN STATE UNIVERSITY CLINICAL CENTER (NPI# 1255629358) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1255629358 |
| Entity Type | Organization |
| Organization Name | MICHIGAN STATE UNIVERSITY CLINICAL CENTER |
| Practice Address |
804 Service Rd Ste A114 East Lansing MI 48824-7038 |
| Practice Telephone | 5173557648 |
| Practice Fax Number | 5174321319 |
| Mailing Telephone | 5173557648 |
| Mailing Fax Number | 5174321319 |
| Enumeration Date | 2011-07-11 |
| Last Update Date | 2012-04-13 |
| Authorized Official Name | CYNTHIA ZALDOKAS (MGR PROVIDER ENROLLMENT) |
| Authorized Official Telephone | 5173553503 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 103T00000X | Psychologist | 6301006498 | MI | Behavioral Health & Social Service Providers |
| Y | 103G00000X | Clinical Neuropsychologist | 6301014684 | MI | Behavioral Health & Social Service Providers |
| Street Address |
804 SERVICE RD STE A114 |
| City | EAST LANSING |
| State | MI |
| Zip Code | 48824-7038 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528680303 | Emilia Elizabeth Mattioli | Psychiatry & Neurology | 965 Fee Road Room A223, East Lansing, MI 48824 | 2020-05-14 |
| 1447871983 | James O'brien | Psychiatry & Neurology | Msu Psychiatry Residency Program, 965 Fee Road, Room A233, East Lansing, MI 48824 | 2020-05-06 |
| 1750916979 | Mulin Xiong | Student in an Organized Health Care Education/Training Program | 965 Wilson Road Suite A110, East Fee Hall, East Lansing, MI 48824 | 2020-03-09 |
| 1821659301 | Tovah Apolonia Aho | Psychiatry & Neurology | Michigan State University Psychiatric Residency, 965 Fee Road, Room A233, East Lansing, MI 48824 | 2019-06-25 |
| 1912564881 | Asmara Theresa Hoo | Psychiatry & Neurology | 965 Fee Road, Room A233, East Lansing, MI 48824 | 2019-05-24 |
| 1790276822 | Traverse Health Clinic and Coalition | Clinic/Center | East Fee Hall 965 Fee Road, Room A222, East Lansing, MI 48824 | 2018-05-24 |
| 1922598515 | Jubin Joseph Cheruvelil | Specialist/Technologist, Other | 446 W. Circle Dr. Room 249 Annex, Justin S. Morrill Hall of Agriculture, East Lansing, MI 48824 | 2018-05-18 |
| 1073003257 | Dawn Arvye Contreras | Health Educator | 446 West Circle Dr., Justin S. Morrill Hall of Agriculture, Room 166, East Lansing, MI 48824 | 2018-05-14 |
| 1710406046 | Kimberly Ann Breukink | Social Worker | 463 East Circle Drive, Michigan State University, Counseling and Psychiatric Services, East Lansing, MI 48824 | 2017-09-19 |
| 1043766314 | Ahmed Jouan | Psychiatry & Neurology | 804 Service Rd A217, East Lansing, MI 48824 | 2016-08-28 |
| Find all providers in zip 48824 | ||||
| Taxonomy Code | 103G00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Clinical Neuropsychologist |
| An individual with a doctorate degree, licensure in clinical psychology and specialized training or board certification in neuropsychology who practices or adheres to the principles of neuropsychology; a specialty within the field of psychology focusing primarily on neurobehavioral functioning. |
| Notes: Source: American Psychological Association, Washington, DC, 1997. [1/1/2007: title modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295871820 | Norman Nmi Abeles | Clinical Neuropsychologist | 953 Rosewood Ave, East Lansing, MI 48823-3126 | 2007-01-30 |
| 1275976615 | Hope Spectrum Health Cc | Clinical Neuropsychologist | 2775 E Lansing Dr, East Lansing, MI 48823-7755 | 2013-04-16 |
| 1528254729 | Huffman Psychology, Pllc | Clinical Neuropsychologist | 4572 S Hagadorn Rd, Suite 2g, East Lansing, MI 48823-5385 | 2007-09-20 |
| 1508819699 | Jennifer L. Huffman | Clinical Neuropsychologist | 4572 S Hagadorn Rd, Suite 2g, East Lansing, MI 48823-5385 | 2006-05-18 |
| 1013991470 | Albert Stanley Aniskiewicz | Clinical Neuropsychologist | 909 Fee Rd Room B119, Michigan State University Department of Psychiatry, East Lansing, MI 48824-1315 | 2005-11-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265046098 | Axon Psychology Group, PC | Clinical Neuropsychologist | 1377 Stonecreek Ct, Saint Joseph, MI 49085-9795 | 2020-08-31 |
| 1548814965 | Emily Nicole Robinett-ferrara | Clinical Neuropsychologist | 14050 Kingston St, Oak Park, MI 48237-1140 | 2019-07-25 |
| 1649782244 | Matthew Kadrich | Clinical Neuropsychologist | 3334 Rochester Rd # 205, Troy, MI 48083-5426 | 2017-11-04 |
| 1992237176 | Lauren Marie Golla | Clinical Neuropsychologist | 111 E Court St Ste 1b, Flint, MI 48502-1649 | 2017-03-28 |
| 1750839783 | Ace Psychological Consultants LLC | Clinical Neuropsychologist | 1920 Livernois Rd Ste D, Troy, MI 48083-1770 | 2016-09-20 |
| 1922556406 | Kenya Hameed | Clinical Neuropsychologist | 111 East Court St, Suite 1b-1, Flint, MI 48502 | 2016-09-14 |
| 1841609369 | Crystal Young | Clinical Neuropsychologist | 1550 E Beltline Ave Se, Suite 340, Grand Rapids, MI 49506-4301 | 2014-08-08 |
| 1497165146 | Woojin Song | Clinical Neuropsychologist | 2101 Commonwealth Blvd Ste C, Ann Arbor, MI 48105-2969 | 2014-05-03 |
| 1831516152 | Ira Lourie, Psy.d., Pllc | Clinical Neuropsychologist | 30051 High Valley Rd, Farmington Hills, MI 48331-2144 | 2014-03-25 |
| 1306272042 | Erin Mark | Clinical Neuropsychologist | 2010 Hogback Rd Ste 6g, Ann Arbor, MI 48105-8800 | 2013-09-25 |
| Find all providers with the same taxonomy | ||||
| City | EAST LANSING |
| Zip Code | 48824 |
Please comment or provide details below to improve the information on MICHIGAN STATE UNIVERSITY CLINICAL CENTER.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.