Provider Demographics
NPI:1528209392
Name:MACOMB COUNTY COMMUNITY MENTAL HELATH
Entity Type:Organization
Organization Name:MACOMB COUNTY COMMUNITY MENTAL HELATH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CASE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:TRAMMEL
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:586-469-5950
Mailing Address - Street 1:21885 DUNHAM RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48036-1030
Mailing Address - Country:US
Mailing Address - Phone:586-469-5950
Mailing Address - Fax:586-469-6637
Practice Address - Street 1:21885 DUNHAM RD
Practice Address - Street 2:SUITE 1
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48036-1030
Practice Address - Country:US
Practice Address - Phone:586-469-5950
Practice Address - Fax:586-469-6637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-09
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI38-600-4868Medicaid