Basic Information
| Provider Information | |||||||||
| NPI: | 1821163882 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SAGINAW PSYCHOLOGICAL SERVICES, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2100 HEMMETER RD | ||||||||
| Address2: | |||||||||
| City: | SAGINAW | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486033944 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897992100 | ||||||||
| FaxNumber: | 9897992637 | ||||||||
| Practice Location | |||||||||
| Address1: | 2100 HEMMETER RD | ||||||||
| Address2: | |||||||||
| City: | SAGINAW | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486033944 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897992100 | ||||||||
| FaxNumber: | 9897992637 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/22/2006 | ||||||||
| LastUpdateDate: | 07/21/2021 | ||||||||
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| AuthorizedOfficialLastName: | MENENDES | ||||||||
| AuthorizedOfficialFirstName: | NATHALIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | COO | ||||||||
| AuthorizedOfficialTelephone: | 9897992100 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PSY.D | ||||||||
| NPICertificationDate: | 07/21/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | MI | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health | 104100000X | MI | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | 103T00000X | MI | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist |
ID Information
| ID | Type | State | Issuer | Description | 680F31140 | 01 | MI | BCBS | OTHER | 730195 | 05 | MI | MEDICAID | 800G36205 | 01 | MI | BCBS | OTHER | 700G36088 | 01 | MI | BCBS | OTHER |