MEDICARE: NORTHERN EMBERS MENTAL HEALTH LLC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1063344869
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHERN EMBERS MENTAL HEALTH LLC.

Provider Business Mailing Address
First Line	:	4020 COPPER VW STE 104
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49684-7041
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4020 COPPER VW STE 104F
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49684-7041
Country	:	US
Telephone Number	:	231-714-4442
Fax Number	:

Authorized Official
Title or Position	:	PSYCHIATRIST
Name	:	ANDREW RIEGEL
Credential	:	DO
Telephone Number	:	248-274-6464

Provider Enumeration Date	:	06/03/2026
Last Update Date	:	06/03/2026

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