Individual provider Active NPI

William Sisco, PSY.D.

  • Clinical Psychologist
  • Traverse City, MI
National Provider Identifier
1457801276
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
0810005386 Issued in VA
Practice address
830 Cottageview Dr Ste 103
Traverse City, MI 49684-2373
Phone
(231) 631-7517
NPI assigned
Oct 4, 2016
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 0810005386 VA Primary

Addresses

Primary practice location

830 Cottageview Dr Ste 103
Traverse City, MI 49684-2373

Mailing address

830 Cottageview Dr Ste 103
Traverse City, MI 49684-2373
Phone (231) 631-7517

Other practice location 1

6105D Arlington Blvd
Falls Church, VA 22044-2950
Phone (703) 819-6177

Other practice location 2

3793 Sandia Pl
Traverse City, MI 49684-4456
Phone (231) 631-7517

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

LicenseStateTypeSpecialty
0810005386VAMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Ethan Siegel, Psy.D. Clinical Past Accepting new patients

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1475539200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757548800000",
    "number": "1457801276",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "830 COTTAGEVIEW DR STE 103",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496842373",
            "telephone_number": "231-631-7517"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "830 COTTAGEVIEW DR STE 103",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496842373",
            "telephone_number": "231-631-7517"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6105D Arlington Blvd",
            "address_purpose": "LOCATION",
            "city": "Falls Church",
            "state": "VA",
            "postal_code": "220442950",
            "country_code": "US",
            "telephone_number": "703-819-6177",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3793 Sandia Pl",
            "address_purpose": "LOCATION",
            "city": "Traverse City",
            "state": "MI",
            "postal_code": "496844456",
            "country_code": "US",
            "telephone_number": "231-631-7517",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SISCO",
        "first_name": "WILLIAM",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-10-04",
        "last_updated": "2025-09-11",
        "certification_date": "2021-11-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "VA",
            "license": "0810005386",
            "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 Sep 11, 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.