Healthcare Provider Details

I. General information

NPI: 1013041698
Provider Name (Legal Business Name): SAGINAW CHIPPEWA INDIAN TRIBE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 02/05/2026
Certification Date: 02/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 S SHEPHERD RD
MOUNT PLEASANT MI
48858-8966
US

IV. Provider business mailing address

2800 S SHEPHERD RD
MOUNT PLEASANT MI
48858-8966
US

V. Phone/Fax

Practice location:
  • Phone: 989-775-4850
  • Fax: 989-775-4851
Mailing address:
  • Phone: 989-775-4850
  • Fax: 989-775-4851

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number370007
License Number StateMI
# 6
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number370007
License Number StateMI

VIII. Authorized Official

Name: LACIE KELLY
Title or Position: BUSINESS SERVICES MANAGER
Credential:
Phone: 989-775-4850