GREAT LAKES PSYCHOLOGY GROUP
Complete NPI Record 1679739700
Community/Behavioral Health in Clarkston, MI

Active since July 29, 2008

6548 TOWN CENTER DR STE D, CLARKSTON, MI 48346(800) 693-1916(248) 605-3525 Get Directions

NPPES record last updated: May 23, 2023. Verified against the NPPES registry weekly; last sync: August 30, 2026.

Record update history: May 23, 2023, Sep 19, 2018, Aug 23, 2018 and 2 more (5 updates tracked since 2017).

Complete NPI Dataset

This page contains the complete raw NPPES record for Great Lakes Psychology Group (NPI 1679739700), a community/behavioral health organization in Clarkston, MI. All 35 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.

Search NPI Record

NPI Record Category

Jump to NPI Field

Registry File Document Utilities

NPI: 1679739700: 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: RICHARD KNEIP, PH.D., P.C.: The name of the organization provider. If the provider is an organization, this is the legal business name.
Provider Other Organization Name: GREAT LAKES PSYCHOLOGY GROUP: Other name by which the organization provider is or has been known.
Provider Other Organization Name Type Code: 3: Code identifying the type of other name. Codes are: 1 = former name; 2 = professional name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other.
Provider First Line Business Mailing Address: PO BOX 772263: 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: DETROIT: The city name in the mailing address of the provider being identified.
Provider Business Mailing Address State Name: MI: 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: 482772263: 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: 8006931916: 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: 2486053525: 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: 6548 TOWN CENTER DR STE D: 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: CLARKSTON: 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: 48346: 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: 8006931916: The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number: 2486053525: The fax number associated with the location address of the provider being identified.
Provider Enumeration Date: 7/29/2008: The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date: 5/23/2023: The date that a record was last updated or changed.
Authorized Official Last Name: KNEIP: 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: RICHARD: The first name of the authorized official.
Authorized Official Middle Name: CARL: The middle name of the authorized official.
Authorized Official Title or Position: PRESIDENT: The title or position of the authorized official.
Authorized Official Telephone Number: 2487012017: The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code 1: 251S00000X: 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.
Provider License Number 1: 6301007060: The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with "provider taxonomy code".
Provider License Number State Code 1: MI: The two-letter state code representing the U.S. state or territory that issued the provider's license. This field is linked to the Provider License Number field and identifies the jurisdiction where that license is valid. A provider may have multiple state codes if they hold licenses in more than one state.
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.
Authorized Official Name Prefix Text: DR.: The prefix used in the name of the authorized official associated with the provider's NPI record. Examples include Mr., Ms., Mrs., Dr., or other common professional or personal prefixes.
Authorized Official Credential Text: PH.D.: The professional credential(s) of the authorized official listed on the provider's NPI record. Examples include MD (Doctor of Medicine), DO (Doctor of Osteopathy), RN (Registered Nurse), DDS (Doctor of Dental Surgery), PhD, or other recognized designations that reflect the official's qualifications.
NPI Certification Date: 5/23/2023: 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 35

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.

1560 Wall St Ste 204

1/35

Naperville, IL 60563-1146 · Phone (800) 693-1916 · Fax (248) 605-3525

3131 S State St Ste 226

2/35

Ann Arbor, MI 48108-1658 · Phone (800) 693-1916 · Fax (248) 605-3525

640 3 Mile Rd NW Ste G

3/35

Grand Rapids, MI 49544-8209 · Phone (800) 693-1916 · Fax (248) 605-3525

4341 S Westnedge Ave Ste 1205

4/35

Kalamazoo, MI 49008-3284 · Phone (800) 693-1916 · Fax (248) 605-3525

2127 University Park Dr Ste 300

5/35

Okemos, MI 48864-5928 · Phone (800) 693-1916 · Fax (248) 605-3525

51 S Washington St Ste F

6/35

Oxford, MI 48371-6418 · Phone (800) 693-1916 · Fax (248) 605-3525

30150 Telegraph Rd Ste 245

7/35

Bingham Farms, MI 48025-4521 · Phone (800) 693-1916 · Fax (248) 605-3525

38600 Van Dyke Ave Ste 101

8/35

Sterling Heights, MI 48312-1171 · Phone (800) 693-1916 · Fax (248) 605-3525

735 S Garfield Ave Ste 200

9/35

Traverse City, MI 49686-3471 · Phone (800) 693-1916 · Fax (248) 605-3525

2710 E Lincoln St Ste 2

10/35

Bloomington, IL 61704-6010 · Phone (800) 693-1916 · Fax (248) 605-3525

1110 W Lake Cook Rd Ste 370

11/35

Buffalo Grove, IL 60089-1991 · Phone (800) 693-1916 · Fax (248) 605-3525

405 E Ash Ave Ste C

12/35

Decatur, IL 62526-6117 · Phone (800) 693-1916 · Fax (248) 605-3525

1400 E Touhy Ave Ste 250

13/35

Des Plaines, IL 60018-3339 · Phone (800) 693-1916 · Fax (248) 605-3525

2250 Point Blvd Ste 101

14/35

Elgin, IL 60123-7869 · Phone (800) 693-1916 · Fax (248) 605-3525

1800 Nations Dr Ste 207

15/35

Gurnee, IL 60031-9173 · Phone (800) 693-1916 · Fax (248) 605-3525

51 W Jackson St Ste 215

16/35

Joliet, IL 60432-2175 · Phone (800) 693-1916 · Fax (248) 605-3525

1910 S Highland Ave Ste 320

17/35

Lombard, IL 60148-6192 · Phone (800) 693-1916 · Fax (248) 605-3525

1639 N Alpine Rd Ste 404

18/35

Rockford, IL 61107-1440 · Phone (800) 693-1916 · Fax (248) 605-3525

1051 Perimeter Dr Ste 700

19/35

Schaumburg, IL 60173-5855 · Phone (800) 693-1916 · Fax (248) 605-3525

7820 Graphic Dr Ste 100

20/35

Tinley Park, IL 60477-6275 · Phone (800) 693-1916 · Fax (248) 605-3525

2923 Marketplace Dr Ste 204

21/35

Fitchburg, WI 53719-5321 · Phone (800) 693-1916 · Fax (248) 605-3525

707 W Moreland Blvd Ste 7

22/35

Waukesha, WI 53188-2400 · Phone (800) 693-1916 · Fax (248) 605-3525

10150 W National Ave Ste 370

23/35

West Allis, WI 53227-2152 · Phone (800) 693-1916 · Fax (248) 605-3525

8120 Penn Ave S Ste 400

24/35

Bloomington, MN 55431-1311 · Phone (800) 693-1916 · Fax (248) 605-3525

2780 Snelling Ave N Ste 102

25/35

Roseville, MN 55113-7115 · Phone (800) 693-1916 · Fax (248) 605-3525

1 Heritage Dr Ste 520

26/35

Southgate, MI 48195-3051 · Phone (800) 693-1916 · Fax (248) 605-3525

18303 E 10 Mile Rd Ste 200

27/35

Roseville, MI 48066-4989 · Phone (800) 693-1916 · Fax (248) 605-3525

41700 Gardenbrook Rd Ste 110

28/35

Novi, MI 48375-1320 · Phone (800) 693-1916 · Fax (248) 605-3525

8341 Office Park Dr Ste E

29/35

Grand Blanc, MI 48439-2077 · Phone (800) 693-1916 · Fax (248) 605-3525

13001 23 Mile Rd Ste 103

30/35

Shelby Township, MI 48315-2767 · Phone (800) 693-1916 · Fax (248) 605-3525

1 Parklane Blvd Ste 1200

31/35

Dearborn, MI 48126-2400 · Phone (800) 693-1916 · Fax (248) 605-3525

39425 Garfield Rd Ste 23

32/35

Clinton Township, MI 48038-4651 · Phone (800) 693-1916 · Fax (248) 605-3525

17940 Farmington Rd

33/35

Livonia, MI 48152-4444 · Phone (800) 693-1916 · Fax (248) 605-3525

89 W South Blvd

34/35

Troy, MI 48085-1611 · Phone (800) 693-1916 · Fax (248) 605-3525

1843 R W Berends Dr SW

35/35

Wyoming, MI 49519-4955 · Phone (800) 693-1916 · Fax (248) 605-3525

No registry entries match your active lookup criteria.