Healthcare Provider Details

I. General information

NPI: 1467373712
Provider Name (Legal Business Name): JACKSON-HILLSDALE COMMUNITY MENTAL HEALTH BOARD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N WEST AVE
JACKSON MI
49202-2179
US

IV. Provider business mailing address

1200 N WEST AVE
JACKSON MI
49202-2179
US

V. Phone/Fax

Practice location:
  • Phone: 517-789-1209
  • Fax: 517-796-9426
Mailing address:
  • Phone: 517-789-1209
  • Fax: 517-796-9426

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: LISA KAY WALDRON
Title or Position: REIMBURSEMENT SUPERVISOR
Credential:
Phone: 517-789-2481