# GRAND TRAVERSE BAND OF OTTAWA AND CHIPPEWA INDIANS

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** GRAND TRAVERSE BAND OF OTTAWA AND CHIPPEWA INDIANS
- **Other names:** Grand Traverse Band Behavioral Health Services
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1477227239
- **Legal business name:** GRAND TRAVERSE BAND OF OTTAWA AND CHIPPEWA INDIANS
- **Authorized official:** MRS. REBECCA LYNN OIEN MOAM (TRIBAL MANAGER)
- **Authorized official phone:** (231) 534-7136

## Contact information

- **Practice address:** 2300 N. STALLMAN RD., PESHAWBESTOWN, MI 49682-9275
- **Practice address phone:** (231) 534-0709
- **Mailing address:** 2605 N. WEST BAY SHORE DR, PESHAEBESTOWN, MI 49682-9275
- **Mailing address phone:** (231) 534-0709

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 163WP0808X | Psychiatric/Mental Health Registered Nurse | — | NULL | Yes |
| 163WP0808X | Psychiatric/Mental Health Registered Nurse | — | — | Yes |

## Other

- **Enumeration date:** 08/05/2021
- **Last updated:** 08/05/2021