Provider Demographics
NPI:1407123482
Name:COMMUNITY MENTAL HEALTH FOR CENTRAL MICHIGAN
Entity Type:Organization
Organization Name:COMMUNITY MENTAL HEALTH FOR CENTRAL MICHIGAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OUTPATIENT THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KARISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-213-4306
Mailing Address - Street 1:5760 SOUTH HURON ROAD
Mailing Address - Street 2:
Mailing Address - City:PINCONNING
Mailing Address - State:MI
Mailing Address - Zip Code:48650
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:218 FAST ICE DRIVE
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48642
Practice Address - Country:US
Practice Address - Phone:989-631-2320
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-19
Last Update Date:2011-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801093039251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health