Healthcare Provider Details

I. General information

NPI: 1467317784
Provider Name (Legal Business Name): MATCH-E-BE-NASH-SHE-WISH BAND OF POTTAWATOMI INDIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2880 MISSION DR
SHELBYVILLE MI
49344-9580
US

IV. Provider business mailing address

2880 MISSION DR
SHELBYVILLE MI
49344-9580
US

V. Phone/Fax

Practice location:
  • Phone: 269-397-1760
  • Fax: 269-397-1763
Mailing address:
  • Phone: 269-397-1760
  • Fax: 269-397-1763

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: JANET SUE REED-HARDIN
Title or Position: BUSINESS OFFICE MANAGER
Credential:
Phone: 269-397-1760