Michelle Rene Petz, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

6801089682 Issued in MI

Practice address

25 W Main St Ste B
Fremont, MI 49412-1186

Phone

(231) 519-7555

NPI assigned

Jan 23, 2020

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Michelle Petz LLC

  • Mental Health Counselor
  • Fremont, MI
  • NPI 1255923991
  NPD Authorized official

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

{
    "created_epoch": "1579737600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1579737600000",
    "number": "1275163776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6333 S BINGHAM AVE",
            "city": "NEWAYGO",
            "state": "MI",
            "postal_code": "493379731",
            "telephone_number": "231-519-7555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25 W MAIN ST STE B",
            "city": "FREMONT",
            "state": "MI",
            "postal_code": "494121186",
            "telephone_number": "231-519-7555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETZ",
        "first_name": "MICHELLE",
        "middle_name": "RENE",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-01-23",
        "last_updated": "2020-01-23",
        "certification_date": "2020-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801089682",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE OF MI",
            "identifier": "6801089682",
            "state": "MI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "secure.simplepractice.com",
            "affiliation": "N",
            "endpointDescription": "secure.simplepratice.com",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "6333 S Bingham Ave",
            "city": "Newaygo",
            "state": "MI",
            "country_code": "US",
            "postal_code": "493379731",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Pawsitive Counseling Center PC
• Rebecca Lynn Payne, O.D.
• Susan Faye Pell, DNP, AGCNS-BC
• Nancy Peterson
• Reese Nicole Petry
• Salena Phillips-Baker
• Physiotherapy Associates Inc
• Daniel Lee Pierce, PA-C
• Pine Medical Group PC
• Pine Medical Group, PC

• Clinical Social Worker in Fremont, MI
• Providers in Fremont, MI by specialty
• Clinical Social Worker in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.