Provider Demographics
NPI:1770610420
Name:MACOMB COUNTY MENTAL HEALTH
Entity type:Organization
Organization Name:MACOMB COUNTY MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST II
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:KASLER
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:586-469-7792
Mailing Address - Street 1:70288 HILLSIDE COURT
Mailing Address - Street 2:
Mailing Address - City:BRUCE TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48065
Mailing Address - Country:US
Mailing Address - Phone:586-752-0171
Mailing Address - Fax:
Practice Address - Street 1:70288 HILLSIDE COURT
Practice Address - Street 2:
Practice Address - City:BRUCE TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48065
Practice Address - Country:US
Practice Address - Phone:586-752-0171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801067674251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health