Healthcare Provider Details

I. General information

NPI: 1275644775
Provider Name (Legal Business Name): TUSCOLA COUNTY COMMUNITY MENTAL HEALTH SERVICES BOARD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 12/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

323 N STATE ST
CARO MI
48723-1537
US

IV. Provider business mailing address

323 N STATE ST PO BOX 239
CARO MI
48723-1537
US

V. Phone/Fax

Practice location:
  • Phone: 989-673-6191
  • Fax: 989-673-1596
Mailing address:
  • Phone: 989-673-6191
  • Fax: 989-673-1596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: SHARON E BEALS
Title or Position: CEO
Credential:
Phone: 989-673-6191