Provider Demographics
NPI:1376512236
Name:NEWAYGO COUNTY MENTAL HEALTH BOARD
Entity Type:Organization
Organization Name:NEWAYGO COUNTY MENTAL HEALTH BOARD
Other - Org Name:NEWAYGO COUNTY MENTAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:MILLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-689-7330
Mailing Address - Street 1:1049 E NEWELL ST
Mailing Address - Street 2:PO BOX 867
Mailing Address - City:WHITE CLOUD
Mailing Address - State:MI
Mailing Address - Zip Code:49349-8795
Mailing Address - Country:US
Mailing Address - Phone:231-689-7330
Mailing Address - Fax:231-689-7345
Practice Address - Street 1:1049 E NEWELL ST
Practice Address - Street 2:
Practice Address - City:WHITE CLOUD
Practice Address - State:MI
Practice Address - Zip Code:49349-8795
Practice Address - Country:US
Practice Address - Phone:231-689-7330
Practice Address - Fax:231-689-7345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-14
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010456692084P0800X
251B00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1043260177OtherNPA - LAFLEUR
MI1417139692OtherNPI - DR. ALT
MI1578686820OtherNPI - BRITT MILLER
MI1225066079OtherNPI - GUNNELL
MI1285674028OtherNPI - LAPO
MI1386969996OtherNPI - PHARMACY
MI1417164575OtherNPI - ZAK
MI1538325543OtherNPI - JO MEYER, LMSW
MI1708066Medicaid
MIP57070010OtherJILLAINE RUPPEL
MIP57070001OtherMEDICARE PTAN
MI1740629450OtherKATHLEEN SMITH
MI1780816520OtherNPI - JILLAINE RUPPEL
MI4892416Medicaid
MI700F260140OtherBLUE CROSS/BLUE SHIELD
MIP57070002OtherMEDICARE PTAN
MIP57070009OtherJO MEYER
MIP57070011OtherMEDICARE - BRITT MILLER
MI1184972309OtherSED WAIVER
MI1376512236OtherNPI - AGENCY
MI4359826Medicaid
MIP57070002Medicare PIN
MIP57070014Medicare PIN
MI1043260177OtherNPA - LAFLEUR
MI1417164575OtherNPI - ZAK
MI1225066079OtherNPI - GUNNELL
MI1376512236OtherNPI - AGENCY