NPIMap

Organization Active NPI

Petoskey Psychological Health and Wellness, PLLC

  • Adult Mental Health Clinic/Center
  • Petoskey, MI
National Provider Identifier
1831666288
Registry record updated Apr 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X
Legal business name
PETOSKEY PSYCHOLOGICAL HEALTH AND WELLNESS, PLLC
Practice address
2810 Charlevoix Rd Ste 102
Petoskey, MI 49770-8421
Phone
(231) 340-9113
Fax
(231) 642-9116
NPI assigned
Oct 24, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2024

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

Authorized official

Name
Dr. Rebecca Roth, PHDNPI 1568659126
Title
Owner
Phone
(231) 340-9113

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Mental Health Clinic/Center 261QM0850X Primary

Addresses

Primary practice location

2810 Charlevoix Rd Ste 102
Petoskey, MI 49770-8421

Mailing address

PO Box 133
Petoskey, MI 49770-0133
Phone (231) 340-9113

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190121000335 MI Part B Supplier - Clinic/Group Practice 5698012201 Receives reassigned benefits from 5 practitioners
Practice locations: Petoskey, MI

National Provider Directory

National Provider Directory

Locations

560 W Mitchell St
Ste 208
Petoskey, MI 49770
Phone (231) 347-4700

2810 Charlevoix Rd
Ste 102
Petoskey, MI 49770
Phone (231) 340-9113

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1540339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1713744000000",
    "number": "1831666288",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 133",
            "city": "PETOSKEY",
            "state": "MI",
            "postal_code": "497700133",
            "telephone_number": "231-340-9113",
            "fax_number": "231-347-5194"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2810 CHARLEVOIX RD STE 102",
            "city": "PETOSKEY",
            "state": "MI",
            "postal_code": "497708421",
            "telephone_number": "231-340-9113",
            "fax_number": "231-642-9116"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETOSKEY PSYCHOLOGICAL HEALTH AND WELLNESS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-10-24",
        "last_updated": "2024-04-22",
        "certification_date": "2024-04-22",
        "status": "A",
        "authorized_official_last_name": "ROTH",
        "authorized_official_first_name": "REBECCA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "231-340-9113",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Petoskey, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2024; 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.