OCTAVE BEHAVIORAL MICHIGAN PC
Complete NPI Record 1356026975
Psychologist in East Lansing, MI

Active since June 20, 2023

2900 WEST RD STE 500, EAST LANSING, MI 48823(415) 360-3833(628) 203-4304 Get Directions

NPPES record last updated: March 9, 2026. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Mar 9, 2026, Dec 18, 2025, Apr 15, 2024 and 1 more (4 updates tracked since 2023).

Complete NPI Dataset

This page contains the complete raw NPPES record for Octave Behavioral Michigan Pc (NPI 1356026975), a psychologist organization in East Lansing, MI. All 29 fields on file are listed with their current values and official NPPES definitions, exactly as recorded in the National Plan and Provider Enumeration System. Only fields that contain data are included, so the number of fields shown varies from one NPI record to another.

Use the tools below to filter fields by category, search within the record, or jump straight to a specific field. You can download the full record as a CSV, JSON, Markdown or text file, or filter first and export only the fields you need. The Print Clean Summary button produces a printer-friendly copy of the record.

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Registry File Document Utilities

NPI: 1356026975: The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
Entity Type Code: 2: Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Employer Identification Number EIN: Not available: The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
Provider Organization Name Legal Business Name: OCTAVE BEHAVIORAL MICHIGAN PC: The name of the organization provider. If the provider is an organization, this is the legal business name.
Provider First Line Business Mailing Address: 625 MARKET ST FL 15: The first line mailing address of the provider being identified. This data element may contain the same information as "Provider first line location address".
Provider Business Mailing Address City Name: SAN FRANCISCO: The city name in the mailing address of the provider being identified.
Provider Business Mailing Address State Name: CA: The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address State name".
Provider Business Mailing Address Postal Code: 941053316: The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as "Provider location address postal code".
Provider Business Mailing Address Country Code If outside U S : US: The country code in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address country code".
Provider Business Mailing Address Telephone Number: 4153603833: The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as "Provider location address telephone number".
Provider Business Mailing Address Fax Number: 6282343048: The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as "Provider location address fax number".
Provider First Line Business Practice Location Address: 2900 WEST RD STE 500: The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City Name: EAST LANSING: The city name in the location address of the provider being identified.
Provider Business Practice Location Address State Name: MI: The State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code: 488236386: The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code If outside U S : US: The country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number: 4153603833: The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number: 6282034304: The fax number associated with the location address of the provider being identified.
Provider Enumeration Date: 6/20/2023: The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date: 3/9/2026: The date that a record was last updated or changed.
Authorized Official Last Name: EVERETT: The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Authorized Official First Name: KYM: The first name of the authorized official.
Authorized Official Title or Position: VICE PRESIDENT, REVENUE OPERATIONS: The title or position of the authorized official.
Authorized Official Telephone Number: 6505042289: The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code 1: 103T00000X: This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
Healthcare Provider Primary Taxonomy Switch 1: Y: This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
Is Organization Subpart: N: Indicates whether the provider is a subpart of a larger organization. This is a single-character code: "Y" means the entity is an organizational subpart, while "N" means it is not. Subparts typically include hospital departments, clinics, or other distinct units that fall under a parent organization.
Healthcare Provider Taxonomy Group 1: 193400000X MULTIPLE SINGLE SPECIALTY GROUP: Specifies whether the provider is part of a single-specialty or multi-specialty business group. The possible values are: 193200000X – Multi-Specialty Group or 193400000X – Single Specialty Group. This field helps distinguish the organizational structure of a provider group.
NPI Certification Date: 3/9/2026: The date on which the National Provider Identifier (NPI) was officially assigned and certified to the provider. This reflects when the provider's NPI record first became active in the NPPES system.

Secondary Practice Locations 40

The first line of the secondary practice location address of the provider being identified. For providers with more than one physical location, this is a secondary practice location address. This address cannot include a Post Office box.

2900 SW Wanamaker Dr Ste 204

1/40

Topeka, KS 66614-4188 · Phone (415) 360-3833 · Fax (628) 234-3048

421 W Main St

2/40

Frankfort, KY 40601-1815 · Phone (415) 360-3833 · Fax (628) 234-3048

45 Memorial Cir

3/40

Augusta, ME 04330-6400 · Phone (415) 360-3833 · Fax (628) 234-3048

221 Bolivar St

4/40

Jefferson City, MO 65101-1572 · Phone (415) 360-3833 · Fax (628) 234-3048

503 S Pierre St

5/40

Pierre, SD 57501-4522 · Phone (415) 360-3833 · Fax (628) 234-3048

10300 Greenbriar Pl

6/40

Oklahoma City, OK 73159-7653 · Phone (415) 360-3833 · Fax (628) 234-3048

222 Jefferson Blvd Ste 200

7/40

Warwick, RI 02888-3855 · Phone (415) 360-3833 · Fax (628) 234-3048

4700 S Mill Ave Ste 5B11

8/40

Tempe, AZ 85282-6736 · Phone (415) 360-3833 · Fax (628) 234-3048

2323 N Campbell Ave Ste 72

9/40

Tucson, AZ 85719-3717 · Phone (415) 360-3833 · Fax (628) 234-3048

3048 E Baseline Rd Ste 107

10/40

Mesa, AZ 85204-7287 · Phone (415) 360-3833 · Fax (628) 234-3048

15150 W Park Pl Ste 215

11/40

Goodyear, AZ 85395-2386 · Phone (415) 360-3833 · Fax (628) 234-3048

3255 E Creosote Ln

12/40

Gilbert, AZ 85298-0853 · Phone (415) 360-3833 · Fax (628) 234-3048

3101 N Central Ave Ste 156

13/40

Phoenix, AZ 85012-3603 · Phone (415) 360-3833 · Fax (628) 234-3048

9160 E Bahia Dr Ste 107

14/40

Scottsdale, AZ 85260-1543 · Phone (415) 360-3833 · Fax (628) 234-3048

2266 S Dobson Rd Ste 200

15/40

Mesa, AZ 85202-6412 · Phone (415) 360-3833 · Fax (628) 234-3048

7689 E Paradise Ln Ste 7

16/40

Scottsdale, AZ 85260-1691 · Phone (415) 360-3833 · Fax (628) 234-3048

1360 N Bullard Ave Ste D209

17/40

Goodyear, AZ 85395-2743 · Phone (415) 360-3833 · Fax (628) 234-3048

18001 N 79th Ave Ste A10

18/40

Glendale, AZ 85308-8389 · Phone (415) 360-3833 · Fax (628) 234-3048

64 E Broadway Rd Ste 200

19/40

Tempe, AZ 85282-1377 · Phone (415) 360-3833 · Fax (628) 234-3048

135 N Pennsylvania St Ste 1610

20/40

Indianapolis, IN 46204-2448 · Phone (415) 360-3833 · Fax (628) 234-3048

501 Louisiana Ave

21/40

Baton Rouge, LA 70802-5921 · Phone (415) 360-3833 · Fax (628) 234-3048

1305 12th Ave Rd

22/40

Nampa, ID 83686-6003 · Phone (415) 360-3833 · Fax (628) 234-3048

505 5th Ave Ste 729

23/40

Des Moines, IA 50309-2318 · Phone (415) 360-3833 · Fax (628) 234-3048

1003 Bishop St

24/40

Honolulu, HI 96813-6400 · Phone (415) 360-3833 · Fax (628) 234-3048

251 Little Falls Dr

25/40

Wilmington, DE 19808-1674 · Phone (415) 360-3833 · Fax (628) 234-3048

300 Spring Building Ste 900

26/40

Little Rock, AR 72201-2425 · Phone (415) 360-3833 · Fax (628) 234-3048

641 S Lawrence St

27/40

Montgomery, AL 36104-5809 · Phone (411) 536-0383 · Fax (628) 234-3048

112 N Curry St

28/40

Carson City, NV 89703-4934 · Phone (415) 360-3833 · Fax (628) 234-3048

110 E Broadway St

29/40

Hobbs, NM 88240-8424 · Phone (415) 360-3833 · Fax (628) 234-3048

10 Ferry St Ste 313

30/40

Concord, NH 03301-5004 · Phone (415) 360-3833 · Fax (628) 234-3048

600 S 2nd St

31/40

Bismarck, ND 58504-5726 · Phone (415) 360-3833 · Fax (628) 234-3048

26 W 6th Ave

32/40

Helena, MT 59601-5035 · Phone (415) 360-3833 · Fax (628) 234-3048

109 Executive Dr Ste 3

33/40

Madison, MS 39110-8497 · Phone (415) 360-3833 · Fax (628) 234-3048

233 S 13th St Ste 1900

34/40

Lincoln, NE 68508-2000 · Phone (415) 360-3833 · Fax (628) 234-3048

625 Market St Fl 15

35/40

San Francisco, CA 94105-3316 · Phone (650) 504-2289

1821 Logan Ave

36/40

Cheyenne, WY 82001-5007 · Phone (415) 360-3833 · Fax (628) 234-3048

209 Washington St W

37/40

Charleston, WV 25302-2348 · Phone (415) 360-3833 · Fax (628) 234-3048

100 N Main St Ste 2

38/40

Barre, VT 05641-4162 · Phone (415) 360-3833 · Fax (628) 234-3048

6044 S 16th St Ste 180

39/40

Phoenix, AZ 85042-4472 · Phone (415) 360-3833 · Fax (628) 234-3048

15 W South Temple Ste 600

40/40

Slc, UT 84101-1536 · Phone (415) 360-3833 · Fax (628) 234-3048

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