Healthcare Provider Details

I. General information

NPI: 1659517944
Provider Name (Legal Business Name): CARISSA PINTAR PSYD,LPC, ATR-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2008
Last Update Date: 08/12/2022
Certification Date: 08/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

376 HILTON SUITE B
FERNDALE MI
48220
US

IV. Provider business mailing address

2425 DALLAS AVE
ROYAL OAK MI
48067-3584
US

V. Phone/Fax

Practice location:
  • Phone: 248-200-9962
  • Fax: 734-324-1566
Mailing address:
  • Phone: 248-200-9962
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6401012259
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6351000427
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number08-156
License Number StateMI
# 4
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6401012259
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: