Active NPI
Pine Rest Christian Mental Health Services
- Psychiatric Hospital
- Traverse City, MI
National Provider Identifier
1124171954
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatric Hospital
- Legal business name
- PINE REST CHRISTIAN MENTAL HEALTH SERVICES
- Practice address
- 700 E Hammond Rd Ste 200
Traverse City, MI 49686-8641 - Phone
- (231) 947-2255
- Fax
- (231) 947-5982
- NPI assigned
- Jan 18, 2007
- Organization subpart
- Yes
- Parent organization
- PINE REST CHRISTIAN MENTAL HEALTH SERVICES
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Diane M Fennema
- Title
- Managed Care Administrator
- Phone
- (616) 281-6372
Specialties & licenses 13
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | |||
| Professional Counselor | 101YP2500X | |||
| Clinical Neuropsychologist | 103G00000X | |||
| Behavior Analyst | 103K00000X | |||
| Psychologist | 103T00000X | |||
| Social Worker | 104100000X | |||
| School Social Worker | 1041S0200X | |||
| Internal Medicine Physician | 207R00000X | |||
| Psychiatry Physician | 2084P0800X | |||
| Occupational Therapist | 225X00000X | |||
| Speech-Language Pathologist | 235Z00000X | |||
| Psychiatric Hospital | 283Q00000X | Primary | ||
| Physician Assistant | 363A00000X |
Addresses
Primary practice location
700 E Hammond Rd Ste 200
Traverse City, MI 49686-8641
Mailing address
300 68TH St SE
Grand Rapids, MI 49548-6927
Phone (616) 455-5000
Other identifiers 8
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 260D17625 | Other | MI | BCBS PSYCHIATRIST |
| 680D16189 | Other | MI | PSYCHOLOGISTS |
| P10D11275 | Other | MI | PSYCHOLOGISTS-DOCTORAL LL |
| 110D148370 | Other | MI | INTERNAL MEDICINE |
| 350D148360 | Other | MI | PEDIATRICS |
| 500D11133 | Other | MI | NURSE PRACTIONERS |
| 800D16222 | Other | MI | SOCIAL WORKERS |
| PSYCHIATIRSTS | Other | MI | MULTISPECIALTY |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | pinerestCMHS@directaddress.pinerest.org | Direct |
National Provider Directory
National Provider Directory- Tax ID family
- Pine Rest Chicago Area
- Part of
- Pine Rest Chicago Area
Other organizations with this tax ID 41
Organizations that report the same tax identification number in the National Provider Directory.
-
- Psychiatry Physician
- Grand Rapids, MI
- NPI 1033129101
-
- Psychiatry Physician
- Grand Haven, MI
- NPI 1063421022
-
- Psychiatry Physician
- Kalamazoo, MI
- NPI 1093726234
-
- Psychiatry Physician
- Grand Rapids, MI
- NPI 1154339521
-
- Psychiatry Physician
- Grand Rapids, MI
- NPI 1174532147
-
- Psychiatry Physician
- Zeeland, MI
- NPI 1184635328
-
- Psychiatric Hospital
- Grand Rapids, MI
- NPI 1235895897
-
- Psychologist
- Grand Rapids, MI
- NPI 1245372150
-
- Nurse Practitioner
- Grand Rapids, MI
- NPI 1255341756
-
- Psychiatry Physician
- Grandville, MI
- NPI 1275544413
-
- Psychiatry Physician
- Holland, MI
- NPI 1285645424
-
- Psychiatric Hospital
- Grand Rapids, MI
- NPI 1306988217
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169078400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1781740800000",
"number": "1124171954",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "300 68TH ST SE",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495486927",
"telephone_number": "616-455-5000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "700 E HAMMOND RD STE 200",
"city": "TRAVERSE CITY",
"state": "MI",
"postal_code": "496868641",
"telephone_number": "231-947-2255",
"fax_number": "231-947-5982"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PINE REST CHRISTIAN MENTAL HEALTH SERVICES",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "PINE REST CHRISTIAN MENTAL HEALTH SERVICES",
"enumeration_date": "2007-01-18",
"last_updated": "2026-06-18",
"certification_date": "2026-06-18",
"status": "A",
"authorized_official_last_name": "FENNEMA",
"authorized_official_first_name": "DIANE",
"authorized_official_middle_name": "M",
"authorized_official_title_or_position": "MANAGED CARE ADMINISTRATOR",
"authorized_official_telephone_number": "616-281-6372"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Counselor",
"state": null,
"license": null,
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Counselor, Professional",
"state": null,
"license": null,
"primary": false
},
{
"code": "103G00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Clinical Neuropsychologist",
"state": null,
"license": null,
"primary": false
},
{
"code": "103K00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Behavior Analyst",
"state": null,
"license": null,
"primary": false
},
{
"code": "103T00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Psychologist",
"state": null,
"license": null,
"primary": false
},
{
"code": "104100000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Social Worker",
"state": null,
"license": null,
"primary": false
},
{
"code": "1041S0200X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Social Worker, School",
"state": null,
"license": null,
"primary": false
},
{
"code": "207R00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Internal Medicine",
"state": null,
"license": null,
"primary": false
},
{
"code": "2084P0800X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": null,
"license": null,
"primary": false
},
{
"code": "225X00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Occupational Therapist",
"state": null,
"license": null,
"primary": false
},
{
"code": "235Z00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Speech-Language Pathologist",
"state": null,
"license": null,
"primary": false
},
{
"code": "283Q00000X",
"taxonomy_group": "",
"desc": "Psychiatric Hospital",
"state": null,
"license": null,
"primary": true
},
{
"code": "363A00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Physician Assistant",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS PSYCHIATRIST",
"identifier": "260D17625",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PSYCHOLOGISTS",
"identifier": "680D16189",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PSYCHOLOGISTS-DOCTORAL LL",
"identifier": "P10D11275",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "INTERNAL MEDICINE",
"identifier": "110D148370",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PEDIATRICS",
"identifier": "350D148360",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NURSE PRACTIONERS",
"identifier": "500D11133",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SOCIAL WORKERS",
"identifier": "800D16222",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MULTISPECIALTY",
"identifier": "PSYCHIATIRSTS",
"state": "MI"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "pinerestCMHS@directaddress.pinerest.org",
"affiliation": "N",
"use": "DIRECT",
"useDescription": "Direct",
"address_1": "300 68th St SE",
"city": "Grand Rapids",
"state": "MI",
"country_code": "US",
"postal_code": "495486927",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Traverse City, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.