Healthcare Provider Details

I. General information

NPI: 1912225111
Provider Name (Legal Business Name): GENESEE COUNTY COMMUNITY MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2010
Last Update Date: 05/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 W 5TH AVE
FLINT MI
48503-2445
US

IV. Provider business mailing address

725 MASON ST
FLINT MI
48503-2421
US

V. Phone/Fax

Practice location:
  • Phone: 810-257-3736
  • Fax:
Mailing address:
  • Phone: 810-257-3736
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DANIS RUSSELL
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 810-257-3707