Provider Demographics
NPI:1154894673
Name:LIST PSYCHOLOGICAL SERVICES, PLC
Entity type:Organization
Organization Name:LIST PSYCHOLOGICAL SERVICES, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTRACT SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARIN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MONTEI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-672-6160
Mailing Address - Street 1:443 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:CARO
Mailing Address - State:MI
Mailing Address - Zip Code:48723-1539
Mailing Address - Country:US
Mailing Address - Phone:989-672-6160
Mailing Address - Fax:989-672-5649
Practice Address - Street 1:110 E HURON AVE
Practice Address - Street 2:
Practice Address - City:BAD AXE
Practice Address - State:MI
Practice Address - Zip Code:48413-1312
Practice Address - Country:US
Practice Address - Phone:989-672-6160
Practice Address - Fax:989-672-5649
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIST PSYCHOLOGICAL SERVICES, PLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-01-08
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
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
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - 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
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction PsychiatryGroup - Multi-Specialty