NPIMap

Organization Active NPI

Octave Behavioral Michigan, PC

  • Psychologist
  • Raleigh, NC
National Provider Identifier
1386498566
Registry record updated Mar 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
Legal business name
OCTAVE BEHAVIORAL MICHIGAN, PC
Practice address
2626 Glenwood Ave Ste 500
Raleigh, NC 27608-1047
Phone
(415) 360-3833
Fax
(628) 234-3048
NPI assigned
Apr 15, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 24, 2025

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

Authorized official

Name
Kym Everett
Title
VP, Revenue Operations
Phone
(415) 360-3833

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103T00000X Primary

Addresses

Primary practice location

2626 Glenwood Ave Ste 500
Raleigh, NC 27608-1047

Mailing address

625 Market St FL 15
San Francisco, CA 94105-3316
Phone (415) 360-3833

Other practice location 1

4037 E Independence Blvd Ste 100
Charlotte, NC 28205-0003
Phone (415) 360-3833

Other practice location 2

200 Doctors Dr Ste M
Jacksonville, NC 28546-6308
Phone (415) 360-3833

National Provider Directory

National Provider Directory
Tax ID family
Octave Behavioral Michigan PC12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

Organizations that report the same tax identification number in the National Provider Directory.

Locations

2626 Glenwood Ave
Ste 500
Raleigh, NC 27608

NPI Registry JSON

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

{
    "created_epoch": "1713139200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1742774400000",
    "number": "1386498566",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "625 MARKET ST FL 15",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941053316",
            "telephone_number": "415-360-3833",
            "fax_number": "628-234-3048"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2626 GLENWOOD AVE STE 500",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276081047",
            "telephone_number": "415-360-3833",
            "fax_number": "628-234-3048"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4037 E Independence Blvd Ste 100",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282050003",
            "country_code": "US",
            "telephone_number": "415-360-3833",
            "fax_number": "628-234-3048",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "200 Doctors Dr Ste M",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "NC",
            "postal_code": "285466308",
            "country_code": "US",
            "telephone_number": "415-360-3833",
            "fax_number": "628-234-3048",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "OCTAVE BEHAVIORAL MICHIGAN, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-04-15",
        "last_updated": "2025-03-24",
        "certification_date": "2025-03-24",
        "status": "A",
        "authorized_official_last_name": "EVERETT",
        "authorized_official_first_name": "KYM",
        "authorized_official_title_or_position": "VP, REVENUE OPERATIONS",
        "authorized_official_telephone_number": "415-360-3833"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Raleigh, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2025; 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.