Individual provider Active NPI

Lisa Youngman-Loose, LPC

  • Professional Counselor
  • Traverse City, MI
National Provider Identifier
1629437918
Registry record updated Nov 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
6401017908 Issued in MI
Practice address
700 Hammond Rd E
Traverse City, MI 49686-8641
Phone
(231) 947-2255
NPI assigned
Feb 16, 2016
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 25, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Other Technician 247200000X
Professional Counselor 101YP2500X 6401017908 MI Primary

Addresses

Primary practice location

700 Hammond Rd E
Traverse City, MI 49686-8641

Mailing address

300 68TH St SE
Grand Rapids, MI 49548-6927

Other practice location 1

203 E Cayuga St
Bellaire, MI 49615-9180
Phone (231) 533-8619

Other practice location 2

1105 Sixth St
Traverse City, MI 49684-2345
Phone (231) 935-6380

Other practice location 3

1050 Silver Dr
Traverse City, MI 49684-5749
Phone (231) 947-2255

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240103002930 MI Practitioner - Mental Health Counselor 5890145874 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pine Rest Christian Mental Health ServicesGroup PAC ID 4981506508, 354 clinicians

Practice addresses (Care Compare)

700 Hammond Rd E
Suite 200
Traverse City, MI 49686-8641
Phone (231) 947-2255

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Teladoc Health Medical Group, P.a. Counselor Current Accepting new patients
Pine Rest Christian Mental Health Services Current Accepting new patients
Pine Rest Christian Mental Health Services Professional CurrentSince Jan 1, 2024 Accepting new patients
North Country Community Mental Health PastSince Mar 28, 2014 Accepting new patients

Locations

700 E Hammond Rd
Ste 200
Traverse City, MI 49686
Phone (231) 947-2255

300 68th St SE
Wyoming, MI 49548
Phone (616) 455-5000

Interoperability endpoints

  • Direct secure messaging: lisayoungmanloose@tdh.allscriptsdirect.net

Organizations & group practices 4

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

NPI Registry JSON

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

{
    "created_epoch": "1455580800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732492800000",
    "number": "1629437918",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 68TH ST SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495486927"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 HAMMOND RD E",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496868641",
            "telephone_number": "231-947-2255"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "203 E Cayuga St",
            "address_purpose": "LOCATION",
            "city": "Bellaire",
            "state": "MI",
            "postal_code": "496159180",
            "country_code": "US",
            "telephone_number": "231-533-8619",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1105 Sixth St",
            "address_purpose": "LOCATION",
            "city": "Traverse City",
            "state": "MI",
            "postal_code": "496842345",
            "country_code": "US",
            "telephone_number": "231-935-6380",
            "fax_number": "231-935-6920",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1050 Silver Dr",
            "address_purpose": "LOCATION",
            "city": "Traverse City",
            "state": "MI",
            "postal_code": "496845749",
            "country_code": "US",
            "telephone_number": "231-947-2255",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "YOUNGMAN-LOOSE",
        "first_name": "LISA",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-02-16",
        "last_updated": "2024-11-25",
        "certification_date": "2024-11-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "247200000X",
            "taxonomy_group": "",
            "desc": "Technician, Other",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MI",
            "license": "6401017908",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Traverse City, MI

Sources for this page

Verify at the official NPI Registry.