NPIMap

Organization Active NPI

Psychnorth

  • Adult Mental Health Clinic/Center
  • Petoskey, MI
National Provider Identifier
1063887230
Registry record updated Dec 14, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X
License
4301089286 Issued in MI
Legal business name
PSYCHNORTH
Practice address
2202 Mitchell Park Dr
Ste 5
Petoskey, MI 49770-8897
Phone
(231) 348-5018
Fax
(844) 711-0200
NPI assigned
Dec 14, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 14, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Jo Ann Haderer, RN
Title
Office Manager
Phone
(231) 348-5018

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Mental Health Clinic/Center 261QM0850X 4301089286 MI Primary

Addresses

Primary practice location

2202 Mitchell Park Dr
Ste 5
Petoskey, MI 49770-8897

Mailing address

2202 Mitchell Park Dr
5
Petoskey, MI 49770-8897
Phone (231) 348-5018

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160216002085 MI Part B Supplier - Clinic/Group Practice 1153626981 Receives reassigned benefits from 5 practitioners
Practice locations: Petoskey, MI

National Provider Directory

National Provider Directory

Locations

2202 Mitchell Park Dr
Ste 5
Petoskey, MI 49770
Phone (231) 348-5018

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1450051200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1450051200000",
    "number": "1063887230",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2202 MITCHELL PARK DR",
            "address_2": "5",
            "city": "PETOSKEY",
            "state": "MI",
            "postal_code": "497708897",
            "telephone_number": "231-348-5018",
            "fax_number": "844-711-0200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2202 MITCHELL PARK DR",
            "address_2": "STE 5",
            "city": "PETOSKEY",
            "state": "MI",
            "postal_code": "497708897",
            "telephone_number": "231-348-5018",
            "fax_number": "844-711-0200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PSYCHNORTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-12-14",
        "last_updated": "2015-12-14",
        "status": "A",
        "authorized_official_last_name": "HADERER",
        "authorized_official_first_name": "JO ANN",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "231-348-5018",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "MI",
            "license": "4301089286",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Petoskey, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.