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General NPI Number Information
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NPI Number | 1891239216
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Entity Type | Organization
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Legal Business Name | JEFFREY WM KATKE OWNER GREAT NORTHERN COUNSELING
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Dates
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Enumeration Date | 12/05/2016
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Last Update Date | 10/09/2024
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Provider Practice Location Address
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Address Line | 814 S OTSEGO AVENUE SUITE E
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City | GAYLORD
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State | MI
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Zip | 49735-2708
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Country | US
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Telephone | 248-318-6360
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Fax |
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Provider Business Mailing Address
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Address Line | 814 S OTSEGO AVENUE SUITE E
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City | GAYLORD
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State | MI
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Zip | 49735
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Country | US
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Telephone | 248-318-6360
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. JEFFREY WILLIAM KATKE
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Credential | LPC
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Telephone | 989-930-4610
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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 | 6401012426
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License Number State | MI
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