Healthcare Provider Details

I. General information

NPI: 1336462001
Provider Name (Legal Business Name): COMMUNITY MENTAL HEALTH FOR CENTRAL MICHIGAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2010
Last Update Date: 11/30/2018
Certification Date:
Deactivation Date: 11/23/2018
Reactivation Date: 11/30/2018

III. Provider practice location address

301 S CRAPO ST SUITE 100
MT PLEASANT MI
48858-2941
US

IV. Provider business mailing address

301 S CRAPO ST SUITE 100
MT PLEASANT MI
48858-2941
US

V. Phone/Fax

Practice location:
  • Phone: 989-773-6961
  • Fax: 989-953-4451
Mailing address:
  • Phone: 989-773-6961
  • Fax: 989-953-4451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number
License Number State

VIII. Authorized Official

Name: JOHN OBERMESIK
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 989-772-5930