JACOB KENNETH TRACY (NPI# 1720585037) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1720585037 |
| Entity Type | Individual |
| Full Name | JACOB KENNETH TRACY |
| Credential | LPC, NCC |
| Practice Address |
410 E Lake Street Suite 100 Petoskey MI 49770 |
| Practice Telephone | 6168894104 |
| Mailing Telephone | 6168894104 |
| Enumeration Date | 2018-04-12 |
| Last Update Date | 2018-04-12 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YP2500X |
Counselor Specialization: Professional |
6401015019 | MI | Behavioral Health & Social Service Providers |
| Street Address |
410 E LAKE STREET SUITE 100 |
| City | PETOSKEY |
| State | MI |
| Zip Code | 49770 |
| 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 |
| 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 |
| 1902201544 | Tana J Nathe | Counselor | 915 Waukazoo Ave., Petoskey, MI 49770 | 2014-10-24 |
| Find all providers in zip 49770 | ||||
| Taxonomy Code | 101YP2500X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Professional |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427510189 | Kaleidoscope Counseling Services Pllc | Counselor | 424 Petoskey Street, Suite C, Petoskey, MI 49770-2618 | 2019-04-02 |
| 1184121485 | Kristen Lynn Herriman | Counselor | 185 Vantage View Dr, Petoskey, MI 49770-9211 | 2018-04-12 |
| 1023546959 | Melissa Sue Merchant | Counselor | 1260 Ajijaak Ave, Petoskey, MI 49770-8330 | 2017-05-23 |
| 1053851519 | Maureen Todd | Counselor | 703 Emmet St, Petoskey, MI 49770 | 2017-03-03 |
| 1003366162 | Up North Family Counseling, LLC | Counselor | 318 E Mitchell St Ste 11, Petoskey, MI 49770-2616 | 2016-10-12 |
| 1750733069 | Chad Alexander | Counselor | 314 1/2 Howard St Ste 2b, Petoskey, MI 49770-4407 | 2016-07-11 |
| 1265891097 | Melissa A Martin | Counselor | 318 E Mitchell St Ste 7, Petoskey, MI 49770-2616 | 2016-02-22 |
| 1902201544 | Tana J Nathe | Counselor | 915 Waukazoo Ave., Petoskey, MI 49770 | 2014-10-24 |
| 1730582453 | Kelly Scolnick Ingleson | Counselor | 10035 E Mitchell Rd, Petoskey, MI 49770-8853 | 2014-10-08 |
| 1194164921 | Carolyn Jean Belknap | Counselor | 1022 Lindell Ave, Petoskey, MI 49770-3230 | 2013-06-14 |
| Find all providers in PETOSKEY | ||||
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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.