MEDICARE: OAKLAND PSYCHOLOGICAL CLINIC, P.C.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YM0800X	Mental Health Counselor
2	103TC0700X	Clinical Psychologist
3	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1538810080
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OAKLAND PSYCHOLOGICAL CLINIC, P.C.

Provider Business Mailing Address
First Line	:	2550 S TELEGRAPH RD STE 250
Second Line	:
City	:	BLOOMFIELD HILLS
State	:	MI
Zip	:	48302-0909
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5123 W ST JOE HWY STE 103
Second Line	:
City	:	LANSING
State	:	MI
Zip	:	48917-4028
Country	:	US
Telephone Number	:	517-323-4099
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT, TREASURER, SECRETARY
Name	:	ELLIOTT RICHELSON
Credential	:	M.D.
Telephone Number	:	904-605-4986

Provider Enumeration Date	:	01/17/2022
Last Update Date	:	03/24/2025

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