EASTWOOD COMMUNITY CLINICS (NPI# 1316165715) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1316165715 |
| Entity Type | Organization |
| Organization Name | EASTWOOD COMMUNITY CLINICS |
| Other Organization Name | EASTWOOD CLINICS |
| Practice Address |
132 Trumbull St Saint Clair MI 48079-5372 |
| Mailing Address |
28000 Dequindre Rd Warren MI 48092-2468 |
| Practice Telephone | 8103295340 |
| Practice Fax Number | 8103298964 |
| Mailing Telephone | (586) 753-0400 |
| Mailing Fax Number | 5867530404 |
| Enumeration Date | 2007-04-23 |
| Last Update Date | 2017-06-08 |
| Authorized Official Name | STEVEN CANDELA (DIRECTOR) |
| Authorized Official Telephone | 5867530400 |
| Authorized Official Credential | LMSW |
| Is Organization Subpart | Y |
| Parent Organization Name | EASTWOOD COMMUNITY CLINICS |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 101Y00000X | Counselor | Behavioral Health & Social Service Providers | ||
| N | 104100000X | Social Worker | Behavioral Health & Social Service Providers | ||
| N | 106H00000X | Marriage & Family Therapist | Behavioral Health & Social Service Providers | ||
| N | 2084P0800X |
Psychiatry & Neurology Specialization: Psychiatry |
Allopathic & Osteopathic Physicians | ||
| Y | 103T00000X | Psychologist | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | BCBSMI OPC NUMBER | 750910702 | 01 |
| Other Name | Type Code |
|---|---|
| Eastwood Clinics | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023386398 | Eastwood Community Clinics | Psychologist | 45660 Schoenherr Rd, Shelby Township, MI 48315-6033 | 2011-12-01 |
| 1285854414 | Eastwood Community Clinics | Counselor | 132 Trumbull St, Saint Clair, MI 48079-5372 | 2007-04-30 |
| 1083832547 | Eastwood Community Clinics | Counselor | 5111 Auto Club Dr, # 120, Dearborn, MI 48126-2749 | 2007-04-23 |
| Street Address |
132 TRUMBULL ST |
| City | SAINT CLAIR |
| State | MI |
| Zip Code | 48079-5372 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710099189 | Gary P Montgomery | Counselor | 132 Trumbull St, Saint Clair, MI 48079-5372 | 2006-08-31 |
| 1508268251 | Courtney Mcclellan | Social Worker | 132 Trumbull St, Saint Clair, MI 48079-5372 | 2014-09-24 |
| 1609021567 | Kimberly A Campolong | Social Worker | 132 Trumbull St, Saint Clair, MI 48079-5372 | 2008-11-19 |
| 1285854414 | Eastwood Community Clinics | Counselor | 132 Trumbull St, Saint Clair, MI 48079-5372 | 2007-04-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548708654 | Mother & Child Mihp of Michigan, Inc. | Exclusive Provider Organization | 1457 South Oakland, St Clair, MI 48079 | 2017-02-09 |
| 1467832568 | Hailey Davis | Speech-Language Pathologist | 5228 Davis Rd, Saint Clair, MI 48079 | 2015-06-03 |
| 1912202144 | Nancy Susan Harrar | Pharmacist | 1167 S. Carney, St. Clair, MI 48079 | 2011-01-19 |
| 1811136393 | Thompson & Schroyer Dds PC | Dentist | 201 N. Riverside, Suite E2a, St. Clair, MI 48079 | 2009-02-06 |
| 1467620831 | Gary D Schroyer | Dentist | 201 N Riverside, Suite E2a, St Clair, MI 48079 | 2008-02-19 |
| 1902941537 | Carol Allen | Optometrist | 201 North Riverside Ave, E9, St Clair, MI 48079 | 2007-02-21 |
| 1730264995 | St Clair Eye Pllc | Optometrist | 1921 Fred Moore Hwy, St Clair, MI 48079 | 2006-10-26 |
| 1700970381 | Carol Jean Kesterke | Counselor | 132 Trumbull, St. Clair, MI 48079 | 2006-10-03 |
| 1629088679 | Nancy H Marshall | Psychiatry & Neurology | 132 Trumbull Street, St Clair, MI 48079 | 2006-08-09 |
| 1568423689 | Robert Reisig Dds PC | Dentist | 1820 Sinclair St, Suite B, St Clair, MI 48079 | 2006-03-29 |
| Find all providers in zip 48079 | ||||
| Taxonomy Code | 103T00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| A psychologist is an individual who is licensed to practice psychology which is defined as the observation, description, evaluation, interpretation, and modification of human behavior by the application of psychological principles, methods, and procedures, for the purpose of preventing or eliminating symptomatic, maladaptive, or undesired behavior and of enhancing interpersonal relationships, work and life adjustment, personal effectiveness, behavioral health, and mental health. The practice of psychology includes, but is not limited to, psychological testing and the evaluation or assessment of personal characteristics, such as intelligence, personality, abilities, interests, aptitudes, and neuropsychological functioning; counseling, psychoanalysis, psychotherapy, hypnosis, biofeedback, and behavior analysis and therapy; diagnosis and treatment of mental and emotional disorder or disability, alcoholism and substance abuse, disorders of habit or conduct, as well as of the psychological aspects of physical illness, accident, injury, or disability; and psycheducational evaluation, therapy, remediation, and consultation. Psychological services may be rendered to individuals, families, groups and the public. |
| Notes: Source: American Psychological Association [1/1/2007: modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922609072 | George Edward Khamis | Psychologist | 25600 Woodward Avenue, Suite 215, Royal Oak, MI 48067 | 2020-11-05 |
| 1932700036 | Estela M Rivero | Psychologist | 2627 Oak Valley Dr Apt 205, Ann Arbor, MI 48103-7705 | 2020-11-04 |
| 1144829037 | Damon Moore | Psychologist | 15450 E Jefferson Ave Ste 180, Grosse Pointe Park, MI 48230-2031 | 2020-10-21 |
| 1073112355 | Sarah Nicole Kesler | Psychologist | 230 Collingwood St Ste 250, Ann Arbor, MI 48103-3845 | 2020-10-19 |
| 1518564947 | Margaret L Blevins | Psychologist | 21769 Meridian Rd, Grosse Ile, MI 48138-1453 | 2020-10-08 |
| 1770197717 | Susan J Goldberg | Psychologist | 442 Randolph St, Northville, MI 48167-1465 | 2020-09-08 |
| 1255944096 | Eric S. Samson | Psychologist | 2045 E West Maple Rd Ste D405, Commerce Township, MI 48390-3801 | 2020-08-30 |
| 1891308904 | Susan Gottlieb Phd LLC | Psychologist | 23800 Orchard Lake Rd Ste 104, Farmington Hills, MI 48336-2561 | 2020-08-28 |
| 1538784012 | Bethany S Gourley | Psychologist | 19855 Outer Dr Ste 300, Dearborn, MI 48124-2022 | 2020-06-10 |
| 1316560303 | Amy K Pruneau LLC | Psychologist | 26755 Middlebelt Rd Ste 140, Farmington Hills, MI 48334 | 2020-05-25 |
| Find all providers with the same taxonomy | ||||
| City | SAINT CLAIR |
| Zip Code | 48079 |
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| 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.