Grand Traverse Assessment and Therapy, PLLC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

Legal business name

GRAND TRAVERSE ASSESSMENT AND THERAPY, PLLC

Practice address

5123 N Royal Dr
Traverse City, MI 49684-9201

Phone

(517) 887-9801

NPI assigned

Sep 10, 2018

Organization subpart

No

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

Authorized official

Name

Robert Fabiano, PHD

Title

Co-Manager

Phone

(517) 243-7027

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1536537600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1548633600000",
    "number": "1912480518",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5123 N ROYAL DR",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496849201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5123 N ROYAL DR",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496849201",
            "telephone_number": "517-887-9801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAND TRAVERSE ASSESSMENT AND THERAPY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-09-10",
        "last_updated": "2019-01-28",
        "status": "A",
        "authorized_official_last_name": "FABIANO",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "CO-MANAGER",
        "authorized_official_telephone_number": "517-243-7027",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Debra Kay Graetz, MD
• Tamara Graf, DIPL.AC. , DIPL. C.H
• Grand Traverse Allergy PC
• Grand Traverse Area Community Living Centers Non Profit Housing Corpor
• Grand Traverse Area Community Living Management Corporation (Brickways)
• Grand Traverse Children's Clinic
• Grand Traverse County Commission on Aging
• Grand Traverse County Health Department
• Grand Traverse County Health Department
• Grand Traverse Dental Care, PC

• Clinical Psychologist in Traverse City, MI
• Providers in Traverse City, MI by specialty
• Clinical Psychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.