Organization
THE BEHAVIORAL MEDICINE CLINIC OF NORTHWEST MICHIGAN, PLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TERRY MARC DICKSON M.D. (OWNER)
(231) 932-1250
Entity
Organization
Contact information
Practice address
745 S GARFIELD AVE, SUITE C, TRAVERSE CITY, MI 49686-3479
(231) 932-1250
(231) 932-1266
Mailing address
745 S GARFIELD AVE, SUITE C, TRAVERSE CITY, MI 49686-3479
(231) 932-1250
(231) 932-1266
Taxonomy
Speciality
Code
Description
License number
State
2080P0006X
Developmental - Behavioral Pediatrics Physician
Primary
4301062201
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0280237
BLUE CROSS BLUE SHIELD MI
MI
05
—
104467082
—
MI
Enumeration date
05/09/2007
Last updated
06/30/2008
Update your record
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