Provider Demographics
NPI:1104715036
Name:COMMUNITY MENTAL HEALTH SERVICES OF ST JOSEPH COUNTY
Entity type:Organization
Organization Name:COMMUNITY MENTAL HEALTH SERVICES OF ST JOSEPH COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CAMERON
Authorized Official - Middle Name:EDWARD BREWSTER
Authorized Official - Last Name:BULLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-467-1001
Mailing Address - Street 1:677 E MAIN ST STE A
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49032-8525
Mailing Address - Country:US
Mailing Address - Phone:269-467-1000
Mailing Address - Fax:
Practice Address - Street 1:677 E MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:MI
Practice Address - Zip Code:49032-8525
Practice Address - Country:US
Practice Address - Phone:269-467-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY MENTAL HEALTH SERVICES OF ST JOSEPH COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-07-03
Last Update Date:2025-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health