Healthcare Provider Details

I. General information

NPI: 1912957143
Provider Name (Legal Business Name): GOGEBIC COUNTY COMMUNITY MENTAL HEALTH AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 08/30/2023
Certification Date: 08/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 W US HIGHWAY 2
WAKEFIELD MI
49968-9515
US

IV. Provider business mailing address

103 W US HIGHWAY 2
WAKEFIELD MI
49968-9515
US

V. Phone/Fax

Practice location:
  • Phone: 906-229-6100
  • Fax: 906-229-6191
Mailing address:
  • Phone: 906-229-6100
  • Fax: 906-229-6191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MRS. TESS GREENOUGH
Title or Position: C.E.O.
Credential:
Phone: 906-229-6100