SOUTH MI PSYCHIATRIC SERVICES LLC (NPI# 1932635521) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1932635521 |
| Entity Type | Organization |
| Organization Name | SOUTH MI PSYCHIATRIC SERVICES LLC |
| Other Organization Name | KALAMAZOO TMS & BEHAVIORAL HEALTH |
| Practice Address |
5930 Lovers Ln Ste 3 Portage MI 49002-1673 |
| Practice Telephone | 2693816950 |
| Practice Fax Number | 2693816954 |
| Mailing Telephone | 2693816950 |
| Mailing Fax Number | 2693816954 |
| Enumeration Date | 2017-05-03 |
| Last Update Date | 2017-05-03 |
| Authorized Official Name | RUQIYA TAREEN (MEDICAL DIRECTOR) |
| Authorized Official Telephone | 2693816950 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TP0016X |
Psychologist Specialization: Prescribing (Medical) |
4301078095 | MI | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | NATIONAL IDENTIFICATION NUMBER | 1932194214 | 01 |
| MI | NATIONAL IDENTIFICATION NUMBER | 1598724122 | 01 |
| Other Name | Type Code |
|---|---|
| Kalamazoo TMS & Behavioral Health | Other Name - Individual/Organization |
| Street Address |
5930 LOVERS LN STE 3 |
| City | PORTAGE |
| State | MI |
| Zip Code | 49002-1673 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740748862 | Amy Jo Fritz | Nurse Practitioner | 5930 Lovers Ln Ste 3, Portage, MI 49002-1673 | 2019-03-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932604204 | Susan Vandewalker | Physical Therapist | 8001 Angling Rd., Portage, MI 49002 | 2018-03-28 |
| 1134634934 | Portage Chiropractic and Wellness Center | Chiropractor | 609 E. Centre, Portage, MI 49002 | 2017-12-04 |
| 1548620537 | Patricia Eid | Behavioral Analyst | 1016 E Milham Ave, Suite 2, Portage, MI 49002 | 2016-03-03 |
| 1386045383 | Pinnacle Senior Care of Kalamazoo, LLC | Home Health | 2725 Airview Blvd Ste 105b, Portage, MI 49002 | 2014-09-09 |
| 1104241611 | Meredith Ayers Holland | Behavioral Analyst | 9616 Portage Road, Portage, MI 49002 | 2014-02-20 |
| 1619211919 | Daketia L Thomas | Massage Therapist | 8314 Portage Rd, Suite D, Kalamazoo, MI 49002 | 2012-11-27 |
| 1831457142 | Kinetic Kids, LLC | Occupational Therapist | 540 East Milham, Portage, MI 49002 | 2012-04-25 |
| 1154689404 | Lauren Michelle Mattaliano | Occupational Therapist | 540 E. Milham Road, Portage, MI 49002 | 2012-04-24 |
| 1114219227 | South Michigan Psychiatric Services LLC | Psychiatry & Neurology | 5390 Lovers Ln, Third Floor, Portage, MI 49002 | 2011-05-07 |
| 1174836316 | Premier Neuropsychiatry Plc | Psychiatry & Neurology | 5930 Lovers Lane, Portage, MI 49002 | 2010-07-16 |
| Find all providers in zip 49002 | ||||
| Taxonomy Code | 103TP0016X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Prescribing (Medical) |
| Those licensed psychologists who have completed specialized, post-doctoral training in psychopharmacology, passed a national proficiency examination in psychopharmacology, and who are authorized by state statute to prescribe medications, in accordance with their state law and state licensing authority, for the evaluation, diagnosis, management and treatment of mental, nervous, emotional, behavioral, and related disorders. |
| Notes: Source: Louisiana Academy of Medical Psychologists Note: Some states issue licenses under Medical Psychologist. [1/1/2007: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629203583 | Temistocles J. Ramirez, M.d., P.C. | Psychologist | 5333 Mcauley Drive, Suite 4112, Ypsilanti, MI 48106 | 2009-05-21 |
| 1184866071 | Shahe Viken Soghomonian | Psychologist | 2260 Fuller Ct Apt 2, Ann Arbor, MI 48105-2324 | 2009-03-24 |
| 1306008875 | Ndidi Ifeoma Okeke | Psychologist | 12064 Ashton Ave, Detroit, MI 48228-1139 | 2008-06-26 |
| 1609082999 | Psychopharmacology Associates PC | Psychologist | 30095 Northwestern Hwy Suite 20a, Farmington Hills, MI 48334 | 2007-05-15 |
| 1457566911 | Margery J. Adelson | Psychologist | 3743 Meadow Ln, Saline, MI 48176-9062 | 2007-05-10 |
| 1417308347 | Pickens Behavioral Services Pllc | Psychologist | 4084 Okemos Rd, Okemos, MI 48864-3258 | 2016-06-22 |
| 1689863870 | Harold Joh, Md.pc | Psychologist | 1547 S Wayne Rd, Westland, MI 48186-5436 | 2007-10-24 |
| 1730377292 | Anthony B. Michaels, D.o., P.C. | Psychologist | 189 Townsend St, Suite 302, Birmingham, MI 48009-6008 | 2007-10-10 |
| 1457551756 | Mpa Group Ltd | Psychologist | 1217 S Euclid Ave, Bay City, MI 48706-3311 | 2007-07-24 |
| 1184821829 | Abdallah Zamaria, M.d. & Barbara Henike, M.d., P.C. | Psychologist | 24001 Greater Mack Ave, Suite C, Saint Clair Shores, MI 48080-1471 | 2007-06-27 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on SOUTH MI PSYCHIATRIC SERVICES LLC.
| 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.