Healthcare Provider Details

I. General information

NPI: 1568333706
Provider Name (Legal Business Name): KALAMAZOO COUNTY COMMUNITY MENTAL HEALTH AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2025
Last Update Date: 09/12/2025
Certification Date: 09/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 E CROSSTOWN PKWY
KALAMAZOO MI
49001-2501
US

IV. Provider business mailing address

610 S BURDICK ST
KALAMAZOO MI
49007-5221
US

V. Phone/Fax

Practice location:
  • Phone: 269-553-7037
  • Fax: 269-553-7106
Mailing address:
  • Phone: 269-553-8000
  • 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

VIII. Authorized Official

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