| Excelsior Psychological Services, Plc | |
|
11111 Hall Rd Ste 105 Utica MI 48317-5799 | |
| (248) 656-5003 | |
| (248) 656-5004 |
| Full Name | Excelsior Psychological Services, Plc |
|---|---|
| Speciality | Psychologist |
| Location | 11111 Hall Rd Ste 105, Utica, Michigan |
| Authorized Official Name and Position | James Andrew Gall (OWNER/CLINICAL DIRECTOR) |
| Authorized Official Contact | 2486565003 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Excelsior Psychological Services, Plc 11111 Hall Rd Ste 105 Utica MI 48317-5799 Ph: (248) 656-5003 | Excelsior Psychological Services, Plc 11111 Hall Rd Ste 105 Utica MI 48317-5799 Ph: (248) 656-5003 |
| NPI Number | 1326441809 |
|---|---|
| Provider Enumeration Date | 09/29/2014 |
| Last Update Date | 05/11/2020 |
| Certification Date | 05/11/2020 |
| Medicare PECOS PAC ID | 7012234644 |
|---|---|
| Medicare Enrollment ID | O20150319001730 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326441809 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TB0200X | Psychologist - Cognitive & Behavioral | 6301011878 (Michigan) | Primary |
| Provider Name | Kelly Lynn Gardiner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447294970 PECOS PAC ID: 9931090933 Enrollment ID: I20040325000041 |
| Provider Name | Patricia C Beasley |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1083841811 PECOS PAC ID: 1456513415 Enrollment ID: I20120509000065 |
| Provider Name | James A Gall |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1215951496 PECOS PAC ID: 4981842911 Enrollment ID: I20130603000049 |
| Provider Name | Robert D Chalmers |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1558631200 PECOS PAC ID: 6800246687 Enrollment ID: I20231219003353 |
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Carol A Johns Phd Pc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 11111 Hall Rd Ste 201, Utica, MI 48317 Phone: 586-254-2994 Fax: 586-791-0419 | |
Mary Cassady Ph.d. Pllc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 11111 Hall Rd, Suite 201, Utica, MI 48317 Phone: 586-254-7383 |