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Organization
BURDETTE AND DOSS PSYCHOLOGICAL SERVICES LC
Active
Organization
BURDETTE AND DOSS PSYCHOLOGICAL SERVICES LC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. BARBARA ANN ELISABETH TYSELL (ADMINISTRATIVE DIRECTOR)
(248) 559-0730
Entity
Organization
Contact information
Practice address
17352 W 12 MILE RD, SUITE 100, SOUTHFIELD, MI 48076-2119
(248) 559-0730
(248) 569-7626
Mailing address
17352 W 12 MILE RD, SUITE 100, SOUTHFIELD, MI 48076-2119
(248) 559-0730
(248) 569-7626
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
—
—
103T00000X
Psychologist
—
—
103TC0700X
Clinical Psychologist
—
—
103TC2200X
Clinical Child & Adolescent Psychologist
—
—
103TP0814X
Psychoanalysis Psychologist
—
—
1041C0700X
Clinical Social Worker
—
—
106H00000X
Marriage & Family Therapist
—
—
2084P0800X
Psychiatry Physician
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
630534
MI
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
630534
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0910921
BCBS OF MICHIGAN
MI
01
—
0911921
BCBS PROVIDER ID MDS
MI
01
—
0912921
BCBS PROVIDER ID PHDS
MI
01
—
0913921
BCBS PROVIDER ID MASTERS
MI
01
—
10921
BCBS MANAGED CARE CODE
MI
01
—
125750
VALUE OPTIONS PROVIDER ID
MI
01
—
1316097488
NPPESJAMES A. COWLEY NPI
MI
01
—
187925000
MAGELLAN IDENTIFIER
MI
01
—
20700
BCBS SUB AB AND MGD CARE
MI
01
—
26 0 F3 2684 0
NASCO GROUP TRACKING ID
MI
01
—
38314498
HAP PROVIDER ID
MI
01
—
630534
STATE SUBSTANCE ABUSE LIC
MI
01
—
750910921
BCBS TRADITIONAL CODE
MI
01
—
7509109210
BCBS NASCO IDENTIFIER
MI
01
—
F037350
WEB DENIS IDENTIFIER
MI
01
—
P69427
BLUE CARE NETWORK PIN
MI
Enumeration date
03/15/2007
Last updated
10/28/2008
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