MEDICARE: LIST PSYCHOLOGICAL SERVICES, PLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101Y00000X	Counselor
2	101YA0400X	Addiction (Substance Use Disorder) Counselor
3	101YM0800X	Mental Health Counselor
4	101YP2500X	Professional Counselor
5	103T00000X	Psychologist
6	103TC0700X	Clinical Psychologist
7	104100000X	Social Worker
8	106H00000X	Marriage & Family Therapist
9	2084P0800X	Psychiatry Physician
10	2084P0802X	Addiction Psychiatry Physician
11	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1306630819
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIST PSYCHOLOGICAL SERVICES, PLC

Provider Business Mailing Address
First Line	:	443 N STATE ST
Second Line	:
City	:	CARO
State	:	MI
Zip	:	48723-1539
Country	:	US
Telephone Number	:	989-672-6160
Fax Number	:	989-672-5649

Provider Business Practice Location Address
First Line	:	4800 S SAGINAW ST STE 1900
Second Line	:
City	:	FLINT
State	:	MI
Zip	:	48507-2677
Country	:	US
Telephone Number	:	810-667-4500
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	JACQUELINE DIANE LIST-HOUSER
Credential	:
Telephone Number	:	989-672-6160

Provider Enumeration Date	:	04/08/2025
Last Update Date	:	04/08/2025

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