Healthcare Provider Details

I. General information

NPI: 1164373858
Provider Name (Legal Business Name): THE NORTHERN LIGHTS COUNSELING COLLECTIVE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3155 LOGAN VALLEY RD
TRAVERSE CITY MI
49684-4772
US

IV. Provider business mailing address

3155 LOGAN VALLEY RD
TRAVERSE CITY MI
49684-4772
US

V. Phone/Fax

Practice location:
  • Phone: 402-677-9083
  • Fax:
Mailing address:
  • Phone: 402-677-9083
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: JEANICE MARIE KNIGHT-BOGATZ
Title or Position: OWNER- AUTHORIZED OFFICIAL
Credential: MS
Phone: 402-677-9083