Healthcare Provider Details

I. General information

NPI: 1093033367
Provider Name (Legal Business Name): CLINTON, EATON, INGHAM, COMMUNITY MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2010
Last Update Date: 05/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

812 E JOLLY RD SUITE 210
LANSING MI
48910-6818
US

IV. Provider business mailing address

812 E JOLLY RD SUITE 210
LANSING MI
48910-6818
US

V. Phone/Fax

Practice location:
  • Phone: 517-346-8200
  • Fax: 517-346-8291
Mailing address:
  • Phone: 517-346-8200
  • Fax: 517-346-8291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PAMELA S FLORY
Title or Position: REIMBURSEMENT MANAGER
Credential:
Phone: 517-346-8209