Provider Demographics
NPI:1891239216
Name:JEFFREY WM KATKE OWNER GREAT NORTHERN COUNSELING
Entity type:Organization
Organization Name:JEFFREY WM KATKE OWNER GREAT NORTHERN COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:KATKE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:989-930-4610
Mailing Address - Street 1:814 S OTSEGO AVENUE
Mailing Address - Street 2:SUITE E
Mailing Address - City:GAYLORD
Mailing Address - State:MI
Mailing Address - Zip Code:49735
Mailing Address - Country:US
Mailing Address - Phone:248-318-6360
Mailing Address - Fax:
Practice Address - Street 1:814 S OTSEGO AVENUE
Practice Address - Street 2:SUITE E
Practice Address - City:GAYLORD
Practice Address - State:MI
Practice Address - Zip Code:49735-2708
Practice Address - Country:US
Practice Address - Phone:248-318-6360
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-05
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401012426101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty