THE BEHAVIORAL MEDICINE CLINIC OF NORTHWEST MICHIGAN, P.C. (NPI# 1154567279) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1154567279 |
| Entity Type | Organization |
| Organization Name | THE BEHAVIORAL MEDICINE CLINIC OF NORTHWEST MICHIGAN, P.C. |
| Practice Address |
745 S Garfield Ave Suite C Traverse City MI 49686-3479 |
| Practice Telephone | 2319321250 |
| Practice Fax Number | 2319321266 |
| Mailing Telephone | 2319321250 |
| Mailing Fax Number | 2319321266 |
| Enumeration Date | 2008-12-18 |
| Last Update Date | 2013-08-27 |
| Authorized Official Name | DR. TERRY M. DICKSON (PRESIDENT) |
| Authorized Official Telephone | 2319321250 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM2500X |
Clinic/Center Specialization: Medical Specialty |
4301062201 | MI | Ambulatory Health Care Facilities |
| Street Address |
745 S GARFIELD AVE SUITE C |
| City | TRAVERSE CITY |
| State | MI |
| Zip Code | 49686-3479 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851505978 | Terry Marc Dickson | Pediatrics | 745 S Garfield Ave, Suite C, Traverse City, MI 49686-3479 | 2007-05-09 |
| 1023259496 | Janet Margaret Morency | Audiologist | 745 S Garfield Ave, Traverse City, MI 49686-5500 | 2009-03-16 |
| 1336353473 | The Behavioral Medicine Clinic of Northwest Michigan, Plc | Pediatrics | 745 S Garfield Ave, Suite C, Traverse City, MI 49686-3479 | 2007-05-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245877208 | Jessica Marie Glowacki | Behavior Technician | 935 Hemlock St, Traverse City, MI 49686 | 2019-12-09 |
| 1568011542 | Joanne Kressley | Technician | 1693 Maylane Apt. 104, Traverse City, MI 49686 | 2019-09-11 |
| 1194283846 | Pace North | PACE Provider Organization | 2325 Garfield Road N., Traverse City, MI 49686 | 2019-03-12 |
| 1245749225 | Margaret Anne Goss | Speech-Language Pathologist | 1105 E. Eighth Street, Traverse City, MI 49686 | 2017-09-22 |
| 1467981811 | Joan Joyce Shirilla | Social Worker | 2124 Twin Eagles Dr, Traverse City, MI 49686 | 2017-06-08 |
| 1770028763 | Rehab and Mobility Systems, LLC | Durable Medical Equipment & Medical Supplies | 707 Parsons, Traverse City, MI 49686 | 2016-12-29 |
| 1629511316 | Kaitlyn Grangood | Social Worker | 415 Munson Avenue, Ste 101, Traverse City, MI 49686 | 2016-11-29 |
| 1811441132 | Jeffrey D Goodwin | Counselor | 430 Fair St., Traverse City, MI 49686 | 2016-08-04 |
| 1053779918 | Thomas Osborne | Counselor | 2014 Phelps Rd., Traverse City, MI 49686 | 2016-02-08 |
| 1982079588 | Marsha Lynne Dallas | Counselor | 2240 South Airport Road, Traverse City, MI 49686 | 2015-12-08 |
| Find all providers in zip 49686 | ||||
| Taxonomy Code | 261QM2500X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Medical Specialty |
| An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer). |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841429792 | Balance for Self Healing | Clinic/Center | 13356 S West Bay Shore Dr, Traverse City, MI 49684-5458 | 2009-07-13 |
| 1811001795 | Kisling Family Chiropractic, P.C. | Clinic/Center | 1323 Cass St, Traverse City, MI 49684-4146 | 2006-08-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629684386 | True Women's Clinic of Grand Rapids, PC | Clinic/Center | 2144 E Paris Ave Se Ste 230, Grand Rapids, MI 49546-6111 | 2020-09-18 |
| 1497397202 | Kimberly Wallace Md PC | Clinic/Center | 12900 W 9 Mile Road, Oak Park, MI 48237 | 2019-10-14 |
| 1265081418 | Cherry Street Services Inc | Clinic/Center | 2125 Wrenwood St Sw Ofc Therapist, Wyoming, MI 49519-2362 | 2019-09-10 |
| 1023662079 | J & D Vision Inc | Clinic/Center | 41821 Garfield Rd, Clinton Twp, MI 48038-1965 | 2019-07-29 |
| 1649839945 | Michigan Institute of Sleep Disorders Pllc | Clinic/Center | 7108 Autumn Hill Dr, West Bloomfield, MI 48323-3904 | 2019-06-10 |
| 1447715131 | Ryan Klanseck, Do | Clinic/Center | 16986 Robbins Rd Ste 140, Grand Haven, MI 49417-2795 | 2019-02-06 |
| 1598242455 | Gratiot Advanced Center LLC | Clinic/Center | 7612 Gratiot Ave Ste 200, Detroit, MI 48213-2822 | 2018-07-24 |
| 1902356140 | Midmichigan Pain | Clinic/Center | 2305 Hawthorn Dr, Suite B, Mt Pleasant, MI 48858-1202 | 2016-10-12 |
| 1184085516 | Hester S Pernell Md Pllc | Clinic/Center | 24628 Ridgeview Dr, Farmington Hills, MI 48336-1905 | 2016-03-12 |
| 1275937625 | Innovative Anesthesia Services PC | Clinic/Center | 847 Parchment Dr Se Ste 105, Grand Rapids, MI 49546 | 2014-10-14 |
| Find all providers with the same taxonomy | ||||
| City | TRAVERSE CITY |
| Zip Code | 49686 |
Please comment or provide details below to improve the information on THE BEHAVIORAL MEDICINE CLINIC OF NORTHWEST MICHIGAN, P.C..
| 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.