Basic Information
| Provider Information | |||||||||
| NPI: | 1386744191 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FRANKLIN | ||||||||
| FirstName: | NICOLE | ||||||||
| MiddleName: | JEANETTE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PSYD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 401 S. BALLENGER HIGHWAY | ||||||||
| Address2: | |||||||||
| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 485323685 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8103421000 | ||||||||
| FaxNumber: | 8103421590 | ||||||||
| Practice Location | |||||||||
| Address1: | G-3200 BEECHER ROAD | ||||||||
| Address2: | SUITE MBI | ||||||||
| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 485323685 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8103421000 | ||||||||
| FaxNumber: | 8103421590 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/22/2006 | ||||||||
| LastUpdateDate: | 06/12/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 6301012757 | MI | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 1021475 | 01 | MCLAREN HEALTH PLAN | OTHER | 1021475 | 01 | MCLAREN HEALTH ADVANTAGE | OTHER | OP250050 | 01 | MI | MCARE GROUP ID NUMBER | OTHER | 680B512650 | 01 | BCBSM-BCN-FEP | OTHER | 056350 | 01 | MI | VALUE OPTIONS MCLAREN GRP | OTHER |