Provider Demographics
NPI:1134470495
Name:MACOMB COUNTY COMMUNITY MENTAL HEALTH
Entity Type:Organization
Organization Name:MACOMB COUNTY COMMUNITY MENTAL HEALTH
Other - Org Name:FIRST RESOURCES & TREATMENT NORTH
Other - Org Type:Other Name
Authorized Official - Title/Position:CASE MANAGER II
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MALICKI
Authorized Official - Suffix:
Authorized Official - Credentials:BS, SST
Authorized Official - Phone:586-466-6218
Mailing Address - Street 1:43740 N GROESBECK HWY
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48036-1139
Mailing Address - Country:US
Mailing Address - Phone:586-469-7629
Mailing Address - Fax:586-469-7662
Practice Address - Street 1:43740 N GROESBECK HWY
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48036-1139
Practice Address - Country:US
Practice Address - Phone:586-469-7629
Practice Address - Fax:586-469-7662
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MACOMB COUNTY COMMUNITY MENTAL HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-09-27
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6803086323251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management