Provider Demographics
NPI:1235342866
Name:LITTLE TRAVERSE BAY BANDS OF ODAWA INDIANS
Entity Type:Organization
Organization Name:LITTLE TRAVERSE BAY BANDS OF ODAWA INDIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUBSTANCE ABUSE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:WOODS
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:231-242-1646
Mailing Address - Street 1:7500 ODAWA CIRCLE
Mailing Address - Street 2:
Mailing Address - City:HARBOR SPRINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49740
Mailing Address - Country:US
Mailing Address - Phone:231-242-1400
Mailing Address - Fax:231-242-1659
Practice Address - Street 1:101 GREENWOOD
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770
Practice Address - Country:US
Practice Address - Phone:231-242-1642
Practice Address - Fax:231-242-1659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI240029251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health