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General NPI Number Information
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NPI Number | 1033280763
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Entity Type | Organization
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Legal Business Name | BERRIEN MENTAL HEALTH AUTHORITY
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Dates
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Enumeration Date | 11/13/2006
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Last Update Date | 01/28/2008
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Provider Practice Location Address
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Address Line | 1485 S. M-139
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City | BENTON HARBOR
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State | MI
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Zip | 49022
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Country | US
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Telephone | 269-925-0585
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Fax | 269-927-1326
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Provider Business Mailing Address
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Address Line | 1485 S. M-139
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City | BENTON HARBOR
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State | MI
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Zip | 49022
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Country | US
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Telephone | 269-925-0585
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Fax | 269-927-1326
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Authorized Official
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Title or Position | CEO
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Name | ALLEN R EDLEFSON
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Credential |
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Telephone | 269-925-0585
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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