Healthcare Provider Details

I. General information

NPI: 1063344869
Provider Name (Legal Business Name): NORTHERN EMBERS MENTAL HEALTH LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4020 COPPER VW STE 104F
TRAVERSE CITY MI
49684-7041
US

IV. Provider business mailing address

4020 COPPER VW STE 104
TRAVERSE CITY MI
49684-7041
US

V. Phone/Fax

Practice location:
  • Phone: 231-714-4442
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: ANDREW RIEGEL
Title or Position: PSYCHIATRIST
Credential: DO
Phone: 248-274-6464