The Behavioral Medicine Clinic of Northwest Michigan, PLC

Primary specialty

Developmental - Behavioral Pediatrics PhysicianTaxonomy code 2080P0006X

License

4301062201 Issued in MI

Legal business name

THE BEHAVIORAL MEDICINE CLINIC OF NORTHWEST MICHIGAN, PLC

Practice address

745 S Garfield Ave
Suite C
Traverse City, MI 49686-3479

Phone

(231) 932-1250

Fax

(231) 932-1266

NPI assigned

May 9, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Terry Marc Dickson, M.D.NPI 1851505978

Title

Owner

Phone

(231) 932-1250

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Terry Marc Dickson, M.D.

  • Developmental - Behavioral Pediatrics Physician
  • Traverse City, MI
  • NPI 1851505978
  NPD (past) Authorized official

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

{
    "created_epoch": "1178668800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214784000000",
    "number": "1336353473",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "745 S GARFIELD AVE",
            "address_2": "SUITE C",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496863479",
            "telephone_number": "231-932-1250",
            "fax_number": "231-932-1266"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "745 S GARFIELD AVE",
            "address_2": "SUITE C",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496863479",
            "telephone_number": "231-932-1250",
            "fax_number": "231-932-1266"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE BEHAVIORAL MEDICINE CLINIC OF NORTHWEST MICHIGAN, PLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-09",
        "last_updated": "2008-06-30",
        "status": "A",
        "authorized_official_last_name": "DICKSON",
        "authorized_official_first_name": "TERRY",
        "authorized_official_middle_name": "MARC",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "231-932-1250",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2080P0006X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics, Developmental - Behavioral Pediatrics",
            "state": "MI",
            "license": "4301062201",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "104467082",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD MI",
            "identifier": "0280237",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Teter Orthotics & Prosthetics, Inc
• Sheali Thayer
• Zoey Thayer
• The Apothecary Shoppe Pharmacies, LLC (Eastland Apothecary Shoppe)
• The Behavioral Medicine Clinic of Northwest Michigan, P.C.
• The Center for Plastic Surgery of Northern Michigan (Steven V Thomas MD and Associates PC)
• The Manor House
• The Maple Clinic of Traverse City, Inc.
• The Maple Clinic, Inc.
• The Northern Lights Counseling Collective PLLC

• Developmental - Behavioral Pediatrics Physician in Traverse City, MI
• Providers in Traverse City, MI by specialty
• Developmental - Behavioral Pediatrics Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2008; 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.