Provider Demographics
NPI:1760452122
Name:IONIA COUNTY COMMUNITY MENTAL HEALTH
Entity Type:Organization
Organization Name:IONIA COUNTY COMMUNITY MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:POSSEHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-527-1790
Mailing Address - Street 1:375 APPLE TREE DR
Mailing Address - Street 2:
Mailing Address - City:IONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48846-7506
Mailing Address - Country:US
Mailing Address - Phone:616-527-1790
Mailing Address - Fax:616-527-0538
Practice Address - Street 1:375 APPLE TREE DR
Practice Address - Street 2:
Practice Address - City:IONIA
Practice Address - State:MI
Practice Address - Zip Code:48846-7506
Practice Address - Country:US
Practice Address - Phone:616-527-1790
Practice Address - Fax:616-527-0538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-26
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI211715928Medicaid
MI774350393Medicaid
MI7509104830OtherBLUE CROSS BLUE SHIELD
MI7509105840OtherBLUE CROSS BLUE SHIELD
MI0M111630Medicare ID - Type UnspecifiedCLINICAL SOCIAL WORKER
MI774350393Medicaid
MI7509105840OtherBLUE CROSS BLUE SHIELD