Provider Demographics
NPI:1245303890
Name:MONROE COMMUNITY MENTAL HEALTH AUTHORITY
Entity type:Organization
Organization Name:MONROE COMMUNITY MENTAL HEALTH AUTHORITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:JANE
Authorized Official - Middle Name:S
Authorized Official - Last Name:TERWILLIGER
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:734-243-7340
Mailing Address - Street 1:1001 S RAISINVILLE RD
Mailing Address - Street 2:PO BOX 0726
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48161-9754
Mailing Address - Country:US
Mailing Address - Phone:734-243-7340
Mailing Address - Fax:734-243-5506
Practice Address - Street 1:1001 S RAISINVILLE RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48161-9754
Practice Address - Country:US
Practice Address - Phone:734-243-7340
Practice Address - Fax:734-243-5506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4355907Medicaid
MI4456552Medicaid
MI0E86264Medicare ID - Type UnspecifiedCLINICAL SOCIAL WORKER
MI4355907Medicaid
MI4456552Medicaid