Healthcare Provider Details

I. General information

NPI: 1619852167
Provider Name (Legal Business Name): ST CLAIR COUNTY COMMUNITY MENTAL HEALTH AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2025
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3111 ELECTRIC AVE
PORT HURON MI
48060-8127
US

IV. Provider business mailing address

3111 ELECTRIC AVE
PORT HURON MI
48060-8127
US

V. Phone/Fax

Practice location:
  • Phone: 810-985-8900
  • Fax: 810-966-3393
Mailing address:
  • Phone: 810-985-8900
  • Fax: 810-966-3393

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: DEBRA JOHNSON
Title or Position: CEO
Credential:
Phone: 810-985-8900