Unknown Individual – Clinical Psychologist, NPI 1013331651

Unknown Individual is a healthcare provider. based in Livonia, Michigan. specializing in Clinical Psychologist. They hold a License No. 6301013572 (MI). The NPI Number for Unknown Individual is 1013331651

Main info

Organization
Inactive
24 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1013331651
Phone
(303) 204-4659
Address
17940 FARMINGTON RD
Deactivation Date
10 April 2025

Doctor Profile

Medical School Name
OTHER
Secondary Phone
8006931916
Graduation Year
2002 (24 years ago)
PAC ID
1052543105
Group Practice PAC ID
4880768415
Professional Enrollment ID
I20140404000185
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience14
Completeness75
Years active:0State licenses:1Digital endpointsOther names

Provider Addresses for Unknown Individual

  • 17940 FARMINGTON RD

    SUITE 280

    LIVONIA, MI 481524444

    Phone: (303) 204-4659

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 48152)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 4880768415View full group profile
NameSpecialtyState
Clinical Social WorkerMI
-IN
Clinical Social WorkerMI
Clinical Social WorkerMI
Clinical PsychologistMI
Clinical Social WorkerWI
Clinical Social WorkerMI
-MI
Clinical Social WorkerMI
Clinical Psychologist, Mental Health CounselorIL

Reviews

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Frequently asked questions

What is the registry number for Unknown Individual?
The registry entry for Unknown Individual shows NPI 1013331651.
Does inactive mean outdated data for Unknown Individual?
Inactive status means the NPI record is not marked active in the public file — verify before making care decisions.
How should patients interpret Unknown Individual's specialty?
The extract shows Clinical Psychologist for Unknown Individual. Clinical services aligned with this taxonomy classification.
Can patients visit Unknown Individual in Livonia, Michigan?
For routing, start with Livonia, Michigan for Unknown Individual, then verify phone and hours locally.
Can I export Unknown Individual's record?
You can download the official NPPES record; we summarize key fields for readability.

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