GREAT LAKES TTC,LLC (NPI# 1659610608) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1659610608 |
| Entity Type | Organization |
| Organization Name | GREAT LAKES TTC,LLC |
| Practice Address |
2206 Mitchell Park Dr Ste 10 Petoskey MI 49770-8674 |
| Mailing Address |
6935 Zenith Heights Rd Boyne City MI 49712-9356 |
| Practice Telephone | 2314872415 |
| Mailing Telephone | 2316755032 |
| Enumeration Date | 2013-02-12 |
| Last Update Date | 2013-02-12 |
| Authorized Official Name | DEREK EVERETT JOHNSON (OWNER) |
| Authorized Official Telephone | 2314872415 |
| Authorized Official Credential | LMSW |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM0850X |
Clinic/Center Specialization: Adult Mental Health |
6801089396 | MI | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | INDIVIDUAL NPI | 1700139904 | 01 |
| Street Address |
2206 MITCHELL PARK DR STE 10 |
| City | PETOSKEY |
| State | MI |
| Zip Code | 49770-8674 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497238117 | Josie Kleinert Schafer | Counselor | 2206 Mitchell Park Dr Ste 10, Petoskey, MI 49770-8674 | 2018-09-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780231985 | Olivia Michelle Seaman | Pharmacist | 1301 U.S. 31 N. Hwy, Petoskey, MI 49770 | 2019-08-22 |
| 1649733148 | Harbor Hall, Inc. | Clinic/Center | 302 Orchard Ridge Drive, Petoskey, MI 49770 | 2019-04-11 |
| 1053802942 | Devin Hueston | Dentist | 231 State St Ste 3, Petoskey, MI 49770 | 2018-05-25 |
| 1720585037 | Jacob Kenneth Tracy | Counselor | 410 E Lake Street, Suite 100, Petoskey, MI 49770 | 2018-04-12 |
| 1013424191 | Timothy Robert La Gasse | Nurse Practitioner | 401 Connable Ave, Petoskey, MI 49770 | 2018-01-10 |
| 1609303676 | Shauna Sue Stark | Nurse Practitioner | 560 W Mitchell St Ste 505, Petoskey, MI 49770 | 2017-05-22 |
| 1053851519 | Maureen Todd | Counselor | 703 Emmet St, Petoskey, MI 49770 | 2017-03-03 |
| 1457719239 | Hufford Vision & Eye Care, PC | Optometrist | 560 West Mitchell, Suite 214, Petoskey, MI 49770 | 2016-02-08 |
| 1053779439 | Kaylyn Schiemann | Specialist/Technologist | 1980 Maxwell Rd, Petoskey, MI 49770 | 2016-02-01 |
| 1669839130 | Stieber Pediatric Dentistry Pllc | Clinic/Center | 1605 Us 131 Highway, Petoskey, MI 49770 | 2016-01-28 |
| Find all providers in zip 49770 | ||||
| Taxonomy Code | 261QM0850X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Adult Mental Health |
| An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in adults. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831666288 | Petoskey Psychological Health and Wellness, Pllc | Clinic/Center | 560 W Mitchell St Ste 208, Petoskey, MI 49770-2278 | 2018-10-24 |
| 1063887230 | Psychnorth | Clinic/Center | 2202 Mitchell Park Dr, Ste 5, Petoskey, MI 49770-8897 | 2015-12-14 |
| 1912390741 | Twin Oaks Mental Health Center, LLC | Clinic/Center | 560 W Mitchell St, Suite 208, Petoskey, MI 49770-2275 | 2015-03-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326648171 | Hillary Fitzsimmons Psyd Pllc | Clinic/Center | 19455 Weyhar St, Livonia, MI 48152 | 2020-10-30 |
| 1356941280 | Peaceful Pride Counseling LLC | Clinic/Center | 3916 Nottingham Ter, Midland, MI 48642-6217 | 2020-10-29 |
| 1205442142 | Comprehensive Health and Home Care Services LLC | Clinic/Center | 2505 Burton St Se Ste 102a, Grand Rapids, MI 49546-4804 | 2020-09-16 |
| 1356961064 | Turning Point Day Program Center | Clinic/Center | 19720 Dorset St, Southfield, MI 48075-3925 | 2020-04-22 |
| 1316585367 | Valarie James, LLC | Clinic/Center | 1290 36th St Sw, Wyoming, MI 49509-3468 | 2019-12-19 |
| 1306484175 | Joy Counseling Services Pllc | Clinic/Center | 1000 W Maple Rd Ste 108, Troy, MI 48084-5306 | 2019-12-12 |
| 1922646751 | Tranquility Christian Counseling Inc | Clinic/Center | 24100 Southfield Rd Ste 320f, Southfield, MI 48075-2819 | 2019-12-11 |
| 1982241964 | Marquette Counseling Service | Clinic/Center | Lori Johnson, 112 W Washington Street Ste A, Marquette, MI 49855-3844 | 2019-12-09 |
| 1033769534 | Honor First | Clinic/Center | 25801 Harper Ave, Saint Clair Shores, MI 48081-2233 | 2019-09-17 |
| 1871140681 | Modern Family Counseling Center | Clinic/Center | 4195 Barcroft Way, West Bloomfield, MI 48323-1803 | 2019-08-26 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.