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Organization
LIST PSYCHOLOGICAL SERVICES, PLC
Active
Organization
LIST PSYCHOLOGICAL SERVICES, PLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACQUELINE THOMPSON (COO)
(989) 672-6160
Entity
Organization
Contact information
Practice address
7484 W MICHIGAN AVE, SUITE C, PIGEON, MI 48755-5200
(989) 453-3051
(989) 453-3052
Mailing address
443 N STATE ST, CARO, MI 48723-1539
(989) 672-6160
(989) 672-5649
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
—
—
103TC0700X
Clinical Psychologist
—
—
104100000X
Social Worker
—
—
1041C0700X
Clinical Social Worker
—
—
106H00000X
Marriage & Family Therapist
—
—
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
—
—
2084P0800X
Psychiatry Physician
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
034530
VALUE OPTIONS
MI
01
—
750910784
BCBS PIN
MI
Enumeration date
08/31/2011
Last updated
08/19/2015
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