Individual provider Active NPI

Tamara K Molby

  • Mental Health Counselor
  • Kalkaska, MI
National Provider Identifier
1902539679
Registry record updated Feb 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
6401224655 Issued in MI
Practice address
419 S Coral St
Kalkaska, MI 49646-2503
Phone
(231) 258-7791
NPI assigned
Jul 8, 2022
Last updated
Feb 4, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 4, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X 6401224655 MI Primary

Addresses

Primary practice location

419 S Coral St
Kalkaska, MI 49646-2503

Mailing address

419 S Coral St
Kalkaska, MI 49646-2503

Other practice location 1

7661 Shippy Rd SW
Fife Lake, MI 49633-8243
Phone (231) 258-7777

Other practice location 2

1700 W Kalkaska Rd
Kalkaska, MI 49646-9147
Phone (231) 258-7922

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: No
  • 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
I20250410002405 MI Practitioner - Mental Health Counselor 9537683552 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6401224655MIMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Kalkaska Memorial Health Center Counselor CurrentSince Jan 16, 2025 Accepting new patients
Kalkaska Memorial Health Center CurrentSince Jan 16, 2025 Accepting new patients

Locations

419 S Coral St
Kalkaska, MI 49646
Phone (231) 258-7500

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1657238400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738627200000",
    "number": "1902539679",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "419 S CORAL ST",
            "city": "KALKASKA",
            "state": "MI",
            "postal_code": "496462503"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "419 S CORAL ST",
            "city": "KALKASKA",
            "state": "MI",
            "postal_code": "496462503",
            "telephone_number": "231-258-7791"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7661 Shippy Rd SW",
            "address_purpose": "LOCATION",
            "city": "Fife Lake",
            "state": "MI",
            "postal_code": "496338243",
            "country_code": "US",
            "telephone_number": "231-258-7777",
            "fax_number": "231-258-7786",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1700 W Kalkaska Rd",
            "address_purpose": "LOCATION",
            "city": "Kalkaska",
            "state": "MI",
            "postal_code": "496469147",
            "country_code": "US",
            "telephone_number": "231-258-7922",
            "fax_number": "231-258-7795",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOLBY",
        "first_name": "TAMARA",
        "middle_name": "K",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-07-08",
        "last_updated": "2025-02-04",
        "certification_date": "2025-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MI",
            "license": "6401224655",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kalkaska, MI

Sources for this page

Verify at the official NPI Registry.