Provider Demographics
NPI:1386744191
Name:FRANKLIN, NICOLE JEANETTE (PSYD)
Entity type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:JEANETTE
Last Name:FRANKLIN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 S. BALLENGER HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3685
Mailing Address - Country:US
Mailing Address - Phone:810-342-1000
Mailing Address - Fax:810-342-1590
Practice Address - Street 1:G-3200 BEECHER ROAD
Practice Address - Street 2:SUITE MBI
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3685
Practice Address - Country:US
Practice Address - Phone:810-342-1000
Practice Address - Fax:810-342-1590
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2010-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301012757103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
1021475OtherMCLAREN HEALTH PLAN
1021475OtherMCLAREN HEALTH ADVANTAGE
MIOP250050OtherMCARE GROUP ID NUMBER
680B512650OtherBCBSM-BCN-FEP
MI056350OtherVALUE OPTIONS MCLAREN GRP
MI056350OtherVALUE OPTIONS MCLAREN GRP