CHASIDY COLLEEN SUMMER FOGG, M.A. LLP LPC — NPI 1831214485 (Licensed & Credentialed Behavioral Health & Social Service Providers

CMS-1500 Box 24J / 33a • NPI

1831214485

Type 1 Individual Rendering/Ordering

HIPAA NUCC Taxonomy • CMS Code

103TC1900X (CMS 62)

Licensed & Credentialed Behavioral Health & Social Service Providers — Psychologist, Counseling

Box 32 Service Location & ZIP+4

4287 RACE RD, LESLIE, MI, 49251-9446

✓ 9-Digit EDI 837 ZIP+4 (49251-9446)

Practice Phone & Referral Fax

(517) 712-7204

Fax: (517) 796-4561

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1831214485 (CHASIDY COLLEEN SUMMER FOGG, M.A. LLP LPC) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

This practitioner does not currently appear in the CMS individual Order & Referring PECOS file (may practice in pediatrics, commercial-only networks, or hospital-employed settings).

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1831214485` (NPI-1 Individual Practitioner)
Provider / Legal Name	CHASIDY COLLEEN SUMMER FOGG, M.A. LLP LPC
Plain-English Specialty	Licensed & Credentialed Behavioral Health & Social Service Providers — Psychologist, Counseling NUCC Code: `103TC1900X` (Psychologist, Counseling)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	4287 RACE RD, LESLIE, MI, 49251-9446
Practice Telephone / Fax	Tel: (517) 712-7204 \| Fax: (517) 796-4561
Administrative Mailing Address	4287 RACE RD, LESLIE, MI, 49251-9446
Enumeration & Last Sync	Enumerated: 2007-03-20 \| CMS Record Updated: 2016-12-20

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

4287 RACE RD, LESLIE, MI, 49251-9446

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Plain-English Taxonomy & CMS Crosswalk (103TC1900X)

What Does Taxonomy Code 103TC1900X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 103TC1900X translates to:
"Licensed & Credentialed Behavioral Health & Social Service Providers — Psychologist, Counseling"

CMS-1500 Medicare Specialty Crosswalk: CMS Code 62 (Psychologist, Clinical)
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Psychologist, Counseling for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (CHASIDY COLLEEN SUMMER FOGG, M.A. LLP LPC)

Typical CPT / Diagnostic Procedures:

Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
Preventive Screening, Patient Counseling & Multidisciplinary Referral

Common Therapeutic Classes:

Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`101YP2500X` — Counselor, Professional Plain English: Licensed & Credentialed Behavioral Health & Social Service Providers — Counselor	State: MI \| License: `6401010112` \| Primary: Secondary
`103TC1900X` — Psychologist, Counseling Plain English: Licensed & Credentialed Behavioral Health & Social Service Providers — Psychologist, Counseling	State: MI \| License: `6301013308` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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CHASIDY COLLEEN SUMMER FOGG, M.A. LLP LPC (NPI #1831214485)