Healthcare Provider Details

I. General information

NPI: 1528519865
Provider Name (Legal Business Name): COPPER COUNTRY MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2016
Last Update Date: 10/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 W MEM DR
HOUGHTON MI
49931-2475
US

IV. Provider business mailing address

901 W MEM DR
HOUGHTON MI
49931-2475
US

V. Phone/Fax

Practice location:
  • Phone: 906-487-7721
  • Fax: 906-487-7710
Mailing address:
  • Phone: 906-487-7721
  • Fax: 906-487-7710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number4704225411
License Number StateMI

VIII. Authorized Official

Name: MICHELLE MORGAN
Title or Position: PSYCHIATRIST
Credential: MD
Phone: 906-482-9400