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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