Provider Demographics
NPI:1821552126
Name:NORTHERN MICHIGAN UNIVERSITY
Entity type:Organization
Organization Name:NORTHERN MICHIGAN UNIVERSITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP FINANCE/ADMINISTRATION
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:GAVIN
Authorized Official - Last Name:LEACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:906-227-2200
Mailing Address - Street 1:1401 PRESQUE ISLE AVENUE
Mailing Address - Street 2:SUITE 158 SERVICES BUILDING
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855
Mailing Address - Country:US
Mailing Address - Phone:906-227-1000
Mailing Address - Fax:
Practice Address - Street 1:1401 PRESQUE ISLE AVENUE
Practice Address - Street 2:158 SERVICES BUILDING
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855
Practice Address - Country:US
Practice Address - Phone:906-227-2994
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHERN MICHIGAN UNIVERSITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-01-31
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Multi-Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty