Autism Center of Northern Michigan

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

1-09-5852 Issued in MI

Legal business name

AUTISM CENTER OF NORTHERN MICHIGAN

Practice address

990 Garfield Woods Dr Ste B
Traverse City, MI 49686-5160

Phone

(231) 497-0555

NPI assigned

Mar 21, 2013

Organization subpart

No

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

Authorized official

Name

Mr. Jordan P Boudreau, MS BCBA

Title

Owner

Phone

(231) 497-0555

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1363824000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1363824000000",
    "number": "1598007171",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "990 GARFIELD WOODS DR STE B",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496865160",
            "telephone_number": "231-497-0555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "990 GARFIELD WOODS DR STE B",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496865160",
            "telephone_number": "231-497-0555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AUTISM CENTER OF NORTHERN MICHIGAN",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-03-21",
        "last_updated": "2013-03-21",
        "status": "A",
        "authorized_official_last_name": "BOUDREAU",
        "authorized_official_first_name": "JORDAN",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "231-497-0555",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MS BCBA"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "MI",
            "license": "1-09-5852",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Erica Ann Austin, DO
• Kyrsten Austin, MS, RD
• Paula Jean Austin, MA, CCC-SLP
• William A Austin, M.D.
• Authentic Life Counseling and Wellness, PLLC
• Constance Averill, PH.D, LMSW, ACSW
• Ann M Avery, NURSE PRACTITIONER
• Ashley Avery
• Bianca Avolio
• Joel Thomas Ayala, OTR

• Community/Behavioral Health Agency in Traverse City, MI
• Providers in Traverse City, MI by specialty
• Community/Behavioral Health Agency in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2013; 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.