MEDICARE: ALLEGAN COUNTY COMMUNITY MENTAL HEALTH SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	750910755	OTHER	MI	BCBS OPC
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215989231
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLEGAN COUNTY COMMUNITY MENTAL HEALTH SERVICES

Provider Business Mailing Address
First Line	:	540 JENNER DR
Second Line	:
City	:	ALLEGAN
State	:	MI
Zip	:	49010-1517
Country	:	US
Telephone Number	:	269-673-6617
Fax Number	:	269-686-5201

Provider Business Practice Location Address
First Line	:	540 JENNER DR
Second Line	:
City	:	ALLEGAN
State	:	MI
Zip	:	49010-1517
Country	:	US
Telephone Number	:	269-673-6617
Fax Number	:	269-686-5201

Authorized Official
Title or Position	:	REIMBURSEMENT MANAGER
Name	:	LYNN YETMAN
Credential	:
Telephone Number	:	269-673-6617

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	09/16/2025

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Directions to “ALLEGAN COUNTY COMMUNITY MENTAL HEALTH SERVICES ” Practice Location

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