Provider Demographics
NPI:1881916310
Name:OAKLAND COUNTY COMMUNITY MENTAL HEALTH AUTHORITY
Entity type:Organization
Organization Name:OAKLAND COUNTY COMMUNITY MENTAL HEALTH AUTHORITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR APPLICATION ANALYST
Authorized Official - Prefix:MS
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:MAUREEN
Authorized Official - Last Name:ANCICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-858-4906
Mailing Address - Street 1:2011 EXECUTIVE HILLS DR
Mailing Address - Street 2:
Mailing Address - City:AUBURN HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48326-2944
Mailing Address - Country:US
Mailing Address - Phone:248-858-1210
Mailing Address - Fax:
Practice Address - Street 1:2011 EXECUTIVE HILLS DR
Practice Address - Street 2:
Practice Address - City:AUBURN HILLS
Practice Address - State:MI
Practice Address - Zip Code:48326-2944
Practice Address - Country:US
Practice Address - Phone:248-858-1210
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-25
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)