Healthcare Provider Details

I. General information

NPI: 1396784112
Provider Name (Legal Business Name): JOHN MICHAEL MCCARTHY ED.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 07/13/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 TURWILL LN
KALAMAZOO MI
49006-4277
US

IV. Provider business mailing address

6886 SPRINGBROOK LN
KALAMAZOO MI
49004-9665
US

V. Phone/Fax

Practice location:
  • Phone: 269-344-4413
  • Fax:
Mailing address:
  • Phone: 269-344-4413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6301005370
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number6301005370
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number6301005370
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: