# LIST PSYCHOLOGICAL SERVICES

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1124357488
- **Authorized official:** DR. DIANE R LIST PHD (CHIEF EXECUTIVE OFFICER)
- **Authorized official phone:** (989) 672-6160

## Contact information

- **Practice address:** 1600 N MICHIGAN AVE, ROOM 506, SAGINAW, MI 48602-5306
- **Practice address phone:** (989) 758-3720
- **Practice address fax:** (989) 758-3760
- **Mailing address:** 443 N STATE ST, CARO, MI 48723-1539
- **Mailing address phone:** (989) 672-6160
- **Mailing address fax:** (989) 672-5649

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101Y00000X | Counselor | — | NULL | — |
| 101Y00000X | Counselor | — | — | — |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | — | MI | Yes |
| 101YM0800X | Mental Health Counselor | — | NULL | — |
| 101YM0800X | Mental Health Counselor | — | — | — |
| 101YP2500X | Professional Counselor | — | NULL | — |
| 101YP2500X | Professional Counselor | — | — | — |
| 103TC0700X | Clinical Psychologist | — | NULL | — |
| 103TC0700X | Clinical Psychologist | — | — | — |
| 104100000X | Social Worker | — | NULL | — |
| 104100000X | Social Worker | — | — | — |
| 1041C0700X | Clinical Social Worker | — | NULL | — |
| 1041C0700X | Clinical Social Worker | — | — | — |
| 106H00000X | Marriage & Family Therapist | — | NULL | — |
| 106H00000X | Marriage & Family Therapist | — | — | — |

## Other

- **Enumeration date:** 12/16/2009
- **Last updated:** 12/16/2009