Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Gregory Pouliot, PHD

Individual provider Clinical Psychologist · NPI 1336549328

Gregory Pouliot, PHD is a Clinical Psychologist in South Bend, Indiana. Qualified in 2014, 12 years ago. Practices with Beacon Medical Group Inc, a 574-clinician group and accepts Medicare assignment. Licensed in Indiana.

Years since qualifying
12
Licensed in
IN
In the registry since
2014
What do these letters mean?
PHD — Doctor of Philosophy
A research doctorate. In healthcare it usually sits alongside a clinical licence.

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Practice location Address checks out

714 N Michigan St
South Bend, IN 46601-1035
Phone: (574) 647-7477
Fax: (574) 647-3655
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Psychologist (primary) Taxonomy 103TC0700X · Licence 20042945A (IN)

Record details

NPI number1336549328
Entity typeIndividual (Type 1)
GenderMale
Credentials PHD
Sole proprietorNo
NPI enumeratedAugust 27, 2014
Last updated in NPPESMarch 31, 2021
Certification dateMarch 31, 2021
Mailing address710 N Niles Ave, South Bend, IN 46617-1924

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCLINICAL PSYCHOLOGIST
Medical schoolOTHER
Graduated 2014 (12 years in practice)
Group practice Beacon Medical Group Inc — 574 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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