EAST BAY PSYCHOLOGY, PC (NPI# 1417346966) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417346966 |
| Entity Type | Organization |
| Organization Name | EAST BAY PSYCHOLOGY, PC |
| Practice Address |
3926 Village Circle Dr. Traverse City MI 49686 |
| Practice Telephone | 2319385900 |
| Practice Fax Number | 2319385900 |
| Mailing Telephone | 2319385900 |
| Mailing Fax Number | 2319385900 |
| Enumeration Date | 2015-01-21 |
| Last Update Date | 2015-01-23 |
| Authorized Official Name | DR. TERENCE LEE BRADLEY (OWNER & CEO) |
| Authorized Official Telephone | 2319385900 |
| Authorized Official Credential | PHD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TC0700X |
Psychologist Specialization: Clinical |
6301002718 | MI | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | BCBS-M | 0B81230 | 01 |
| MI | BCBS-M | 0Z5488 | 01 |
| Street Address |
3926 VILLAGE CIRCLE DR. |
| City | TRAVERSE CITY |
| State | MI |
| Zip Code | 49686 |
| 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 | 103TC0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Clinical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881178325 | Jacob White Ph.d., Pllc | Psychologist | 3537 W. Front Street, Suite F, Traverse City, MI 49684 | 2018-09-20 |
| 1518361567 | Paul D Winkler Behavioral Health Services Plc | Psychologist | 2240 S Airport Rd W, Suite C, Traverse City, MI 49684-4714 | 2014-10-20 |
| 1205102241 | Sandra E Helmick | Psychologist | 105 Hall St Unit A, Traverse City, MI 49684-2288 | 2012-03-23 |
| 1306071071 | Management & Behavior Consultants, P. C. | Psychologist | 955 E 8th St Ste 2, Traverse City, MI 49686-2785 | 2009-05-24 |
| 1922130467 | Roxanne Kay Fall | Psychologist | 955 E. 8th Street, Suite 2, Traverse City, MI 49686-2785 | 2007-03-11 |
| 1851435721 | Melissa Ann Bullard | Psychologist | 697 Hannah Ave Ste D, Traverse City, MI 49686-3399 | 2007-02-16 |
| 1760521314 | Ann Clare O'donnell | Psychologist | 2150 S Airport Rd W, Suite A, Traverse City, MI 49684-4705 | 2007-02-06 |
| 1477604601 | Wayne Vern Simmons | Psychologist | 2226 S Airport Rd W, Ste. A, Traverse City, MI 49684-4706 | 2007-01-15 |
| 1033268149 | Terence Lee Bradley | Psychologist | 3926 Village Circle Dr, Traverse City, MI 49686-6305 | 2007-01-09 |
| 1245307370 | Jennifer J. Sowle | Psychologist | 236 1/2 E Front St, Traverse City, MI 49684-2526 | 2006-11-30 |
| Find all providers in TRAVERSE CITY | ||||
| City | TRAVERSE CITY |
| Zip Code | 49686 |
Please comment or provide details below to improve the information on EAST BAY PSYCHOLOGY, PC.
| 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.