Provider Demographics
NPI:1073647731
Name:BURDETTE AND DOSS PSYCHOLOGICAL SERVICES LC
Entity type:Organization
Organization Name:BURDETTE AND DOSS PSYCHOLOGICAL SERVICES LC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BARBARA ANN
Authorized Official - Middle Name:ELISABETH
Authorized Official - Last Name:TYSELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-559-0730
Mailing Address - Street 1:17352 W 12 MILE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-2119
Mailing Address - Country:US
Mailing Address - Phone:248-559-0730
Mailing Address - Fax:248-569-7626
Practice Address - Street 1:17352 W 12 MILE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-2119
Practice Address - Country:US
Practice Address - Phone:248-559-0730
Practice Address - Fax:248-569-7626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 101YA0400X, 101YM0800X, 103T00000X, 103TC0700X, 103TC2200X, 1041C0700X, 106H00000X, 2084P0800X, 103TP0814X, 101YP2500X
MI630534261QR0405X, 261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use DisorderGroup - Multi-Specialty
No103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysisGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI750910921OtherBCBS TRADITIONAL CODE
MI20700OtherBCBS SUB AB AND MGD CARE
MI7509109210OtherBCBS NASCO IDENTIFIER
MI1316097488OtherNPPESJAMES A. COWLEY NPI
MI26 0 F3 2684 0OtherNASCO GROUP TRACKING ID
MI38314498OtherHAP PROVIDER ID
MI7509109210OtherVALUEOPTIONS
MI0911921OtherBCBS PROVIDER ID MDS
MI0913921OtherBCBS PROVIDER ID MASTERS
MI630534OtherSTATE SUBSTANCE ABUSE LIC
MI0912921OtherBCBS PROVIDER ID PHDS
MI10921OtherBCBS MANAGED CARE CODE
MIF037350OtherWEB DENIS IDENTIFIER
MI187925000OtherMAGELLAN IDENTIFIER
MI0910921OtherBCBS OF MICHIGAN
MI125750OtherVALUE OPTIONS PROVIDER ID
MIP69427OtherBLUE CARE NETWORK PIN
MI0M67590Medicare ID - Type UnspecifiedJAMES COWLEY LSW MASTERS
MI0F37268001Medicare PIN
MI0913921OtherBCBS PROVIDER ID MASTERS
MIF037350OtherWEB DENIS IDENTIFIER
MI125750OtherVALUE OPTIONS PROVIDER ID
MIOM30330Medicare ID - Type UnspecifiedEDWARD ROBERTS MD AND MDS
MI0F37268011Medicare PIN
MI20700OtherBCBS SUB AB AND MGD CARE
MI10921OtherBCBS MANAGED CARE CODE
MIF43390Medicare UPIN
MI7509109210OtherBCBS NASCO IDENTIFIER