Provider Demographics
NPI:1982958443
Name:LAPEER COUNTY COMMUNITY MENTAL HEALTH
Entity Type:Organization
Organization Name:LAPEER COUNTY COMMUNITY MENTAL HEALTH
Other - Org Name:LAPEER CMH - CHILD WAIVER
Other - Org Type:Other Name
Authorized Official - Title/Position:LEAD SUPPORT STAFF
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:FANTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-667-0500
Mailing Address - Street 1:1570 SUNCREST DR
Mailing Address - Street 2:
Mailing Address - City:LAPEER
Mailing Address - State:MI
Mailing Address - Zip Code:48446-1154
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1570 SUNCREST DR
Practice Address - Street 2:
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-1154
Practice Address - Country:US
Practice Address - Phone:810-667-0500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LAPEER COUNTY COMMUNITY MENTAL HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-11-06
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health