Active NPI
Mark Anthony Pettinato, LLPC
- Mental Health Counselor
- Manistee, MI
National Provider Identifier
1699221358
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 6401015039
- Practice address
- 310 Glocheski Dr
Manistee, MI 49660-2639 - Phone
- (231) 309-1781
- Fax
- (231) 723-1735
- NPI assigned
- Aug 31, 2016
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 6401015039 | MI | Primary |
Addresses
Primary practice location
310 Glocheski Dr
Manistee, MI 49660-2639
Mailing address
310 Glocheski Dr
Manistee, MI 49660-2639
Phone (231) 309-1781
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
| License | State | Type | Specialty |
|---|---|---|---|
| 6401015039 | MI | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1472601600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1472601600000",
"number": "1699221358",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "310 GLOCHESKI DR",
"city": "MANISTEE",
"state": "MI",
"postal_code": "496602639",
"telephone_number": "231-309-1781",
"fax_number": "231-723-1735"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "310 GLOCHESKI DR",
"city": "MANISTEE",
"state": "MI",
"postal_code": "496602639",
"telephone_number": "231-309-1781",
"fax_number": "231-723-1735"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETTINATO",
"first_name": "MARK",
"middle_name": "ANTHONY",
"name_prefix": "Mr.",
"credential": "LLPC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-08-31",
"last_updated": "2016-08-31",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "MI",
"license": "6401015039",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Manistee, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.