Insight Behavioral Wellness of Northern Michigan LLC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

6301017346 Issued in MI

Legal business name

INSIGHT BEHAVIORAL WELLNESS OF NORTHERN MICHIGAN LLC

Practice address

537 S Garfield Ave Ste B
Traverse City, MI 49686-3484

Phone

(440) 915-8497

NPI assigned

May 16, 2018

Last updated

May 16, 2018By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Barbara A Doremus, PHD

Title

Owner

Phone

(404) 975-0313

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Barbara A. Diedrick, PH.D.

  • Clinical Psychologist
  • Willoughby, OH
  • NPI 1487076964

  MI

  Medicare reassignment NPD
• Roxanne Kay Fall, PH.D., L.L.P.

  • Clinical Social Worker
  • Traverse City, MI
  • NPI 1922130467
  NPD (past)
• Mark McKelvy Garner, PH.D.

  • Clinical Psychologist
  • Traverse City, MI
  • NPI 1558438838
  NPD (past)
• Amelia Beth Siders, PH.D.

  • Psychologist
  • Traverse City, MI
  • NPI 1568594083
  NPD (past)

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

{
    "created_epoch": "1526428800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1526428800000",
    "number": "1942790894",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "537 S GARFIELD AVE STE B",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496863484",
            "telephone_number": "440-915-8497"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "537 S GARFIELD AVE STE B",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496863484",
            "telephone_number": "440-915-8497"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INSIGHT BEHAVIORAL WELLNESS OF NORTHERN MICHIGAN LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-16",
        "last_updated": "2018-05-16",
        "status": "A",
        "authorized_official_last_name": "DOREMUS",
        "authorized_official_first_name": "BARBARA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "404-975-0313",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MI",
            "license": "6301017346",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Katherine Ingersoll, LPN
• Michelle Ingersoll
• Christina Mary-Scott Ingham, N.P.
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• Interlochen Emergency Group, P.C.
• International Center for Integral Health and Education

• 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 May 16, 2018; 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.