Healthcare Provider Details

I. General information

NPI: 1497749279
Provider Name (Legal Business Name): SHIAWASSEE COUNTY COMMUNITY MENTAL HEALTH AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 01/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 INDUSTRIAL DR
OWOSSO MI
48867-9775
US

IV. Provider business mailing address

1555 INDUSTRIAL DR
OWOSSO MI
48867-9775
US

V. Phone/Fax

Practice location:
  • Phone: 989-723-6791
  • Fax: 989-725-5061
Mailing address:
  • Phone: 989-723-6791
  • Fax: 989-725-5061

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 StateMI

VIII. Authorized Official

Name: LAURA STEPHEN
Title or Position: FINANCIAL SERVICES SUPERVISOR
Credential:
Phone: 989-723-0732