=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043860802
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANCHOR MENTAL HEALTH LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/13/2019
-----------------------------------------------------
Last Update Date | 09/13/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 214 SOUTH ST
-----------------------------------------------------
City | JONESVILLE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49250-1054
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 517-826-5167
-----------------------------------------------------
Fax | 517-826-5024
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 214 SOUTH ST
-----------------------------------------------------
City | JONESVILLE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49250-1054
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 517-826-5167
-----------------------------------------------------
Fax | 517-826-5024
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATIVE
-----------------------------------------------------
Name | MISS DENISE ANN MCLAUGHLIN
-----------------------------------------------------
Credential | MA
-----------------------------------------------------
Telephone | 517-425-1368
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------