MEDICARE: GREAT LAKES ONLINE COUNSELING LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1073445235
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREAT LAKES ONLINE COUNSELING LLC

Provider Business Mailing Address
First Line	:	602 BLOOMFIELD RD STE 300
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49686-2835
Country	:	US
Telephone Number	:	231-590-9852
Fax Number	:

Provider Business Practice Location Address
First Line	:	602 BLOOMFIELD RD
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49686-2835
Country	:	US
Telephone Number	:	231-735-8250
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER
Name	:	MR. JOSEPH SANOK
Credential	:	MA, LPC
Telephone Number	:	231-590-9852

Provider Enumeration Date	:	06/02/2026
Last Update Date	:	06/02/2026

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