Healthcare Provider Details

I. General information

NPI: 1265865935
Provider Name (Legal Business Name): KALAMAZOO COMMUNITY MENTAL HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2013
Last Update Date: 08/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

418 W KALAMAZOO AVE
KALAMAZOO MI
49007-3334
US

IV. Provider business mailing address

3299 GULL RD
KALAMAZOO MI
49048-1281
US

V. Phone/Fax

Practice location:
  • Phone: 269-553-7015
  • 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 Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: JEFF PATTON
Title or Position: CEO
Credential:
Phone: 269-553-8002