| Northern Lakes Community Mental Health Authority | |
|
105 Hall St Suite A Traverse City MI 49684-2288 | |
| (231) 922-4850 | |
| (231) 935-3856 |
| Full Name | Northern Lakes Community Mental Health Authority |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 105 Hall St, Traverse City, Michigan |
| Authorized Official Name and Position | Nancy Stevenson (COO) |
| Authorized Official Contact | 2319224850 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Northern Lakes Community Mental Health Authority 105 Hall St Suite A Traverse City MI 49684-2288 Ph: (231) 922-4850 | Northern Lakes Community Mental Health Authority 105 Hall St Suite A Traverse City MI 49684-2288 Ph: (231) 922-4850 |
| NPI Number | 1669572657 |
|---|---|
| Provider Enumeration Date | 09/22/2006 |
| Last Update Date | 11/28/2023 |
| Certification Date | 11/28/2023 |
| Medicare PECOS PAC ID | 8022921154 |
|---|---|
| Medicare Enrollment ID | O20031117000682 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669572657 | NPI | - | NPPES |
| 77 4540057 | Medicaid | MI | |
| 0750910830 | Other | MI | BCBSM OPC CADILLAC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Penelope Elaine Spencer |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1043384175 PECOS PAC ID: 5597771238 Enrollment ID: I20060303000576 |
| Provider Name | Krista Patz |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1427396092 PECOS PAC ID: 1254621881 Enrollment ID: I20160609001165 |
| Provider Name | Jill Rountree |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1396291977 PECOS PAC ID: 7214210822 Enrollment ID: I20170206001495 |
| Provider Name | Julie Olson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1578986162 PECOS PAC ID: 3274804836 Enrollment ID: I20170801001917 |
| Provider Name | Andrea Lea Cassell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1083136105 PECOS PAC ID: 1355609199 Enrollment ID: I20180125002382 |
| Provider Name | Genell Sivek |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1316486269 PECOS PAC ID: 9830529973 Enrollment ID: I20200414000411 |
| Provider Name | Cynthia Oconnel |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1386117976 PECOS PAC ID: 8123459096 Enrollment ID: I20200508000700 |
| Provider Name | Jade M Dodde |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1356852529 PECOS PAC ID: 9537568860 Enrollment ID: I20210519000101 |
| Provider Name | Colette Gomez |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1265881064 PECOS PAC ID: 5698165447 Enrollment ID: I20211209001499 |
| Provider Name | Deborah Ehle |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1942674015 PECOS PAC ID: 4880087238 Enrollment ID: I20220207001182 |
| Provider Name | Kelley Samuels-good |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1841748977 PECOS PAC ID: 5698168052 Enrollment ID: I20220207001621 |
| Provider Name | Alyssa Gregory |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1265897722 PECOS PAC ID: 1951789353 Enrollment ID: I20220525001579 |
| Provider Name | Erica Longstreet |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1730693961 PECOS PAC ID: 9739568833 Enrollment ID: I20220621000910 |
| Provider Name | Chad Koehn |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1710326178 PECOS PAC ID: 2668821596 Enrollment ID: I20231218001287 |
| Provider Name | Kathryn Marie Mikel |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1164903142 PECOS PAC ID: 7618327222 Enrollment ID: I20231222000788 |
| Provider Name | Michael Charles Corby |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1407288103 PECOS PAC ID: 1153763644 Enrollment ID: I20240529003991 |
Katharine Westie Phd Pllc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 3537 W Front St, Suite F, Traverse City, MI 49684 Phone: 231-632-4282 | |
E. A. Austin Do Pc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 110 S Madison St, Traverse City, MI 49684 Phone: 231-946-0911 Fax: 231-935-0343 | |
Kelly K Greene Pc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 921 W 11th St Ste 1w, Traverse City, MI 49684 Phone: 231-929-9040 Fax: 231-929-5586 | |
Pintar Psychological Services, Pc Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 12719 S West Bay Shore Dr, Suite #9, Traverse City, MI 49684 Phone: 231-714-7054 Fax: 231-943-1032 | |
Senior Outreach Services Inc Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 4996 Ridgewood Rd, Traverse City, MI 49686 Phone: 800-671-1767 | |
Mindspot Counseling, Pllc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 4833 Silver Pines Road, Traverse City, MI 49685 Phone: 231-538-2046 | |
Engel Mind Body Psychiatry Pllc Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 4620 N Us Highway 31 N, Traverse City, MI 49686 Phone: 231-938-2010 Fax: 231-938-2012 |