MEDICARE: THE NORTHERN LIGHTS COUNSELING COLLECTIVE PLLC

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1164373858
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE NORTHERN LIGHTS COUNSELING COLLECTIVE PLLC

Provider Business Mailing Address
First Line	:	3155 LOGAN VALLEY RD
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49684-4772
Country	:	US
Telephone Number	:	402-677-9083
Fax Number	:

Provider Business Practice Location Address
First Line	:	3155 LOGAN VALLEY RD
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49684-4772
Country	:	US
Telephone Number	:	402-677-9083
Fax Number	:

Authorized Official
Title or Position	:	OWNER- AUTHORIZED OFFICIAL
Name	:	JEANICE MARIE KNIGHT-BOGATZ
Credential	:	MS
Telephone Number	:	402-677-9083

Provider Enumeration Date	:	02/07/2026
Last Update Date	:	05/28/2026

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