Provider Demographics
NPI:1710036843
Name:THE MAPLE CLINIC OF TRAVERSE CITY, INC.
Entity Type:Organization
Organization Name:THE MAPLE CLINIC OF TRAVERSE CITY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:CROSS
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:231-946-9575
Mailing Address - Street 1:525 S UNION ST
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-3246
Mailing Address - Country:US
Mailing Address - Phone:231-946-9575
Mailing Address - Fax:231-946-9575
Practice Address - Street 1:525 S UNION ST
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-3246
Practice Address - Country:US
Practice Address - Phone:231-946-9575
Practice Address - Fax:231-946-9575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0B86047Medicare ID - Type UnspecifiedGROUP