NPIMap

Organization Active NPI

Little Traverse Psychiatric Associates, PC

  • Psychiatry Physician
  • Petoskey, MI
National Provider Identifier
1992857338
Registry record updated May 13, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
LITTLE TRAVERSE PSYCHIATRIC ASSOCIATES, PC
Practice address
2206 Mitchell Park Dr
Ste 10
Petoskey, MI 49770-8674
Phone
(231) 487-2415
Fax
(231) 487-6569
NPI assigned
Jan 17, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 13, 2013

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

Authorized official

Name
Dr. Robert George Fawcett, M.D.
Title
President
Phone
(231) 487-2415

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084P0800X MI Primary

Addresses

Primary practice location

2206 Mitchell Park Dr
Ste 10
Petoskey, MI 49770-8674

Mailing address

2206 Mitchell Park Dr
Ste 10
Petoskey, MI 49770-8674
Phone (231) 487-2415

Other identifiers 1

IdentifierTypeStateIssuer
260B41060OtherMIBLUE CROSS

National Provider Directory

National Provider Directory

Locations

2206 Mitchell Park Dr
Ste 10
Petoskey, MI 49770
Phone (231) 487-2415

Practitioners & affiliated clinicians

Practitioners 5

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": "1168992000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1368403200000",
    "number": "1992857338",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2206 MITCHELL PARK DR",
            "address_2": "STE 10",
            "city": "PETOSKEY",
            "state": "MI",
            "postal_code": "497708674",
            "telephone_number": "231-487-2415",
            "fax_number": "231-487-6569"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2206 MITCHELL PARK DR",
            "address_2": "STE 10",
            "city": "PETOSKEY",
            "state": "MI",
            "postal_code": "497708674",
            "telephone_number": "231-487-2415",
            "fax_number": "231-487-6569"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LITTLE TRAVERSE PSYCHIATRIC ASSOCIATES, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-17",
        "last_updated": "2013-05-13",
        "status": "A",
        "authorized_official_last_name": "FAWCETT",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "GEORGE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "231-487-2415",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "260B41060",
            "state": "MI"
        }
    ],
    "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 May 13, 2013; 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.