Michelle Petrik, LADC

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

304222 Issued in MN

Practice address

102 Miller St
New York Mills, MN 56567-4333

Phone

(218) 385-2991

NPI assigned

Aug 25, 2015

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1440460800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1440460800000",
    "number": "1487021549",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102 MILLER ST",
            "city": "NEW YORK MILLS",
            "state": "MN",
            "postal_code": "565674333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 MILLER ST",
            "city": "NEW YORK MILLS",
            "state": "MN",
            "postal_code": "565674333",
            "telephone_number": "218-385-2991"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETRIK",
        "first_name": "MICHELLE",
        "credential": "LADC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-08-25",
        "last_updated": "2015-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MN",
            "license": "304222",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• New York Mills Family Spine Clinic
• Northwoods Velvaere Studio
• Otter Tail County Public Health
• Peaceful Mind Mental Health, LLC
• Perham Hospital District
• Rachel K. Grieger DDS PA
• Annastasia Ramig, MSW, LICSW
• Leslie Sandberg, RN
• Sanford Clinic North
• Sanford Medical Center Fargo

• Addiction (Substance Use Disorder) Counselor in New York Mills, MN
• Providers in New York Mills, MN by specialty
• Addiction (Substance Use Disorder) Counselor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2015; 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.