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General NPI Number Information
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NPI Number | 1164373858
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Entity Type | Organization
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Legal Business Name | THE NORTHERN LIGHTS COUNSELING COLLECTIVE PLLC
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Dates
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Enumeration Date | 02/07/2026
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Last Update Date | 02/07/2026
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Provider Practice Location Address
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Address Line | 2150 S AIRPORT RD W
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City | TRAVERSE CITY
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State | MI
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Zip | 49684-4705
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Country | US
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Telephone | 402-677-9083
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Fax |
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Provider Business Mailing Address
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Address Line | 145 PEACH TREE DR
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City | TRAVERSE CITY
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State | MI
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Zip | 49696-7918
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Country | US
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Telephone | 402-677-9083
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JEANICE KNIGHT-BOGATZ
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Credential | LPC
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Telephone | 231-590-9216
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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