Active NPI
Carrie Douglas
- Professional Counselor
- Traverse City, MI
National Provider Identifier
1124570197
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 6401015031
- Practice address
- 415 Cass St
Suite 2a & 2D
Traverse City, MI 49684-2589 - Phone
- (231) 346-5216
- Fax
- (231) 943-2590
- NPI assigned
- Oct 26, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 6401015031 | MI | Primary |
Addresses
Primary practice location
415 Cass St
Suite 2a & 2D
Traverse City, MI 49684-2589
Mailing address
415 Cass St
Suite 2a & 2D
Traverse City, MI 49684-2589
Phone (231) 346-5216
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6401015031 | MI | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1477440000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1477440000000",
"number": "1124570197",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "415 CASS ST",
"address_2": "SUITE 2A & 2D",
"city": "TRAVERSE CITY",
"state": "MI",
"postal_code": "496842589",
"telephone_number": "231-346-5216",
"fax_number": "231-943-2590"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "415 CASS ST",
"address_2": "SUITE 2A & 2D",
"city": "TRAVERSE CITY",
"state": "MI",
"postal_code": "496842589",
"telephone_number": "231-346-5216",
"fax_number": "231-943-2590"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOUGLAS",
"first_name": "CARRIE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-10-26",
"last_updated": "2016-10-26",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "MI",
"license": "6401015031",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"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 Oct 26, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.