Healthcare Provider Details

I. General information

NPI: 1932467248
Provider Name (Legal Business Name): JAMIE PINTAR PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2012
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12719 S WEST BAY SHORE DR SUITE #9
TRAVERSE CITY MI
49684-5489
US

IV. Provider business mailing address

12719 S WEST BAY SHORE DR STE 9
TRAVERSE CITY MI
49684-5489
US

V. Phone/Fax

Practice location:
  • Phone: 231-714-7054
  • Fax:
Mailing address:
  • Phone: 231-735-1903
  • Fax: 231-943-1032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301013916
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number6301013916
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: