Healthcare Provider Details

I. General information

NPI: 1477225506
Provider Name (Legal Business Name): KALAMAZOO COUNTY COMMUNITY MENTAL HEALTH AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2021
Last Update Date: 09/14/2023
Certification Date: 09/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 E CROSSTOWN PKWY
KALAMAZOO MI
49001-2501
US

IV. Provider business mailing address

2030 PORTAGE ST
KALAMAZOO MI
49001-3836
US

V. Phone/Fax

Practice location:
  • Phone: 269-373-6000
  • Fax: 269-373-4951
Mailing address:
  • Phone: 269-553-8018
  • Fax: 269-553-8012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: HOLLY GREENE
Title or Position: CREDENTIALING
Credential:
Phone: 269-553-8027