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General NPI Number Information
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NPI Number | 1962103309
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Entity Type | Organization
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Legal Business Name | UP NORTH PSYCHOLOGY
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Dates
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Enumeration Date | 03/13/2023
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Last Update Date | 03/13/2023
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Provider Practice Location Address
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Address Line | 145 W MAIN ST STE 200
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City | GAYLORD
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State | MI
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Zip | 49735-1300
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Country | US
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Telephone | 989-370-8056
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Fax |
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Provider Business Mailing Address
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Address Line | 6604 WOODCOCK CT
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City | GAYLORD
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State | MI
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Zip | 49735-8746
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Country | US
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Telephone | 989-370-8056
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Fax |
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Authorized Official
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Title or Position | OWNER, OPERATOR
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Name | JEANETTE SAYRE
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Credential | MA LLP CAADC
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Telephone | 989-370-8056
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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