Organization
NORTHERN LAKES COMMUNITY MENTAL HEALTH AUTHORITY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NANCY STEVENSON (COO)
(231) 922-4850
Entity
Organization
Contact information
Practice address
105 HALL STREET, SUITE A, TRAVERSE CITY, MI 49684
(231) 922-4850
(231) 935-3856
Mailing address
105 HALL STREET, SUITE A, TRAVERSE CITY, MI 49684
(231) 922-4850
(231) 935-3856
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0260B81097
BCBSM NON OPC PHYSICIANS
MI
01
—
104985
PREFERRED CHOICES
MI
05
—
21 4540048
—
MI
01
—
M007933
TRI CARE CHAMPUS
MI
Enumeration date
09/26/2006
Last updated
01/04/2024
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