Provider Demographics
NPI:1013041698
Name:SAGINAW CHIPPEWA INDIAN TRIBE BEHAVIORAL HEALTH PROGRAM
Entity type:Organization
Organization Name:SAGINAW CHIPPEWA INDIAN TRIBE BEHAVIORAL HEALTH PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:AME
Authorized Official - Middle Name:
Authorized Official - Last Name:EDSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-775-4850
Mailing Address - Street 1:2800 S SHEPHERD RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-8966
Mailing Address - Country:US
Mailing Address - Phone:989-775-4850
Mailing Address - Fax:989-775-4851
Practice Address - Street 1:2800 S SHEPHERD RD
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-8966
Practice Address - Country:US
Practice Address - Phone:989-775-4850
Practice Address - Fax:989-775-4851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X, 171M00000X, 2084P0800X, 101YM0800X
MI370007261QR0405X, 324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use DisorderGroup - Multi-Specialty
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility