Collective Impact Services LLC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

Legal business name

COLLECTIVE IMPACT SERVICES LLC

Practice address

616 Elizabeth St
Petoskey, MI 49770

Phone

(231) 758-6776

NPI assigned

Mar 27, 2023

Organization subpart

No

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

Authorized official

Name

Julie ClarkNPI 1164892873

Title

Owner

Phone

(231) 838-6099

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Locations

Practitioners 1

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

• Julie Kathleen Clark, M.S., LPC, CRC, MITS

  • Professional Counselor
  • Petoskey, MI
  • NPI 1164892873
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1679875200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1681689600000",
    "number": "1083317010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "616 ELIZABETH ST",
            "city": "PETOSKEY",
            "state": "MI",
            "postal_code": "497702704"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "616 ELIZABETH ST",
            "city": "PETOSKEY",
            "state": "MI",
            "postal_code": "49770",
            "telephone_number": "231-758-6776"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLLECTIVE IMPACT SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-03-27",
        "last_updated": "2023-04-17",
        "certification_date": "2023-03-27",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "JULIE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "231-838-6099"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kara E Cockfield, MD
• Alisha Marie Cole, PA
• Blair Cole
• Chaim Benjoseph Colen, M.D., PH.D.
• Harry T. Colfer, M.D.
• Anna Collins, LMSW
• Irene F Connolly, M.D.
• Danielle Nicole Cook, PA-C
• Rachel Cook
• Ryan Cooper, CCAR

• Professional Counselor in Petoskey, MI
• Providers in Petoskey, MI by specialty
• Professional Counselor in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2023; 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.