NPIMap

Organization Active NPI

Kids Creek Family Counseling, LLC

  • Clinical Social Worker
  • Traverse City, MI
National Provider Identifier
1598218315
Registry record updated Mar 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
KIDS CREEK FAMILY COUNSELING, LLC
Practice address
5024 N Royal Dr Ste B
Traverse City, MI 49684-9230
Phone
(231) 632-4490
NPI assigned
Jul 28, 2016
Last updated
Mar 17, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2018

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

Authorized official

Name
Amber Lee, LMSWNPI 1437378254
Title
Owner
Phone
(231) 632-4490

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X NU Primary

Addresses

Primary practice location

5024 N Royal Dr Ste B
Traverse City, MI 49684-9230

Mailing address

PO Box 2257
Chesterton, IN 46304-0357
Phone (219) 926-8320

Other practice location 1

513 S Cedar St
Kalkaska, MI 49646-9454
Phone (231) 632-4490

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170110000671 MI Part B Supplier - Clinic/Group Practice 4385925122 Receives reassigned benefits from 9 practitioners
Practice locations: Kalkaska, MI; Williamsburg, MI; Traverse City, MI

National Provider Directory

National Provider Directory

Locations

5024 N Royal Dr
Ste B
Traverse City, MI 49684
Phone (231) 276-1999

3871 M 72 E
Williamsburg, MI 49690
Phone (231) 276-1999

Practitioners & affiliated clinicians

Practitioners 21

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.

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1469664000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1521244800000",
    "number": "1598218315",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2257",
            "city": "CHESTERTON",
            "state": "IN",
            "postal_code": "463040357",
            "telephone_number": "219-926-8320"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5024 N ROYAL DR STE B",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496849230",
            "telephone_number": "231-632-4490"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "513 S Cedar St",
            "address_purpose": "LOCATION",
            "city": "Kalkaska",
            "state": "MI",
            "postal_code": "496469454",
            "country_code": "US",
            "telephone_number": "231-632-4490",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "KIDS CREEK FAMILY COUNSELING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-07-28",
        "last_updated": "2018-03-17",
        "status": "A",
        "authorized_official_last_name": "LEE",
        "authorized_official_first_name": "AMBER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "231-632-4490",
        "authorized_official_credential": "LMSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "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 Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.