Provider Demographics
NPI:1881622892
Name:COMMUNITY MENTAL HEALTH FOR CENTRAL MICHIGAN
Entity type:Organization
Organization Name:COMMUNITY MENTAL HEALTH FOR CENTRAL MICHIGAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KROGMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-772-5930
Mailing Address - Street 1:301 S CRAPO ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-2941
Mailing Address - Country:US
Mailing Address - Phone:989-773-6961
Mailing Address - Fax:989-773-1968
Practice Address - Street 1:301 S CRAPO ST
Practice Address - Street 2:SUITE 100
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-2941
Practice Address - Country:US
Practice Address - Phone:989-773-6961
Practice Address - Fax:989-773-1968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-29
Last Update Date:2023-04-21
Deactivation Date:2018-11-23
Deactivation Code:
Reactivation Date:2018-11-30
Provider Licenses
StateLicense IDTaxonomies
MI6401006136101Y00000X
MI6301011699103T00000X
MI68010848561041C0700X
225XM0800X
MI251S00000X
MI4704196395363LP0808X
MI51010108732084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No225XM0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistMental HealthGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI750910703OtherBLUE CROSS/BLUE SHIELD
MI774352754Medicaid
MI1009798OtherMCLAREN HEALTH PLAN
MI214344340Medicaid
MI774352754Medicaid
MI0N37280Medicare PIN
MI1009798OtherMCLAREN HEALTH PLAN