Healthcare Provider Details

I. General information

NPI: 1306164017
Provider Name (Legal Business Name): COPPER COUNTRY COMMUNITY MENTAL HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2010
Last Update Date: 05/06/2010
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: 906-482-9400
  • Fax: 906-483-0269
Mailing address:
  • Phone: 906-482-9400
  • Fax: 906-483-0269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateMI

VIII. Authorized Official

Name: MR. LAWRENCE J POLLACK
Title or Position: EXECUTIVE DIRECTOR
Credential: PHD.
Phone: 906-482-9400