Provider Demographics
NPI:1528570322
Name:ALLEGAN COUNTY COMMUNITY MENTAL HEALTH SERVICES
Entity Type:Organization
Organization Name:ALLEGAN COUNTY COMMUNITY MENTAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REIMBURSEMENT COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:YETMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-673-6617
Mailing Address - Street 1:PO BOX 130
Mailing Address - Street 2:
Mailing Address - City:ALLEGAN
Mailing Address - State:MI
Mailing Address - Zip Code:49010-0130
Mailing Address - Country:US
Mailing Address - Phone:269-673-6617
Mailing Address - Fax:269-686-5201
Practice Address - Street 1:3285 122ND AVE
Practice Address - Street 2:
Practice Address - City:ALLEGAN
Practice Address - State:MI
Practice Address - Zip Code:49010-9511
Practice Address - Country:US
Practice Address - Phone:269-673-6617
Practice Address - Fax:269-673-2738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-02
Last Update Date:2017-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care