GREAT LAKES TTCLLC NPI 1659610608

NPI Information

  • NPI: 1659610608
  • Provider Name: GREAT LAKES TTC,LLC
  • Classification: Clinic/Center - 261QM0850X
  • Specialization: Adult Mental Health
  • Entity Type: Organization
  • Address: 2206 MITCHELL PARK DR STE 10
    PETOSKEY, MI
    ZIP 49770
  • Phone: (231) 487-2415

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NPI Details

GREAT LAKES TTC,LLC is an adult mental health clinic center in Petoskey, MI. The provider is an entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in adults. GREAT LAKES TTC,LLC NPI is 1659610608. The provider is registered as an organization entity type.

The provider's business location address is:

2206 MITCHELL PARK DR STE 10
PETOSKEY, MI
ZIP 49770-674
Phone: (231) 487-2415

The provider's authorized official is Derek Everett Johnson .
The authorized official title is Owner and has the following contact phone number (231) 487-2415.

The enumeration date for this NPI number is 2/12/2013 and was last updated on 2/12/2013.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261QM0850XClinic/CenterAdult Mental Health6801089396MICHIGANYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
11700139904OTHERMICHIGANINDIVIDUAL NPI

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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