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General NPI Number Information
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NPI Number | 1104715036
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Entity Type | Organization
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Legal Business Name | COMMUNITY MENTAL HEALTH SERVICES OF ST JOSEPH COUNTY
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Dates
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Enumeration Date | 07/03/2025
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Last Update Date | 07/03/2025
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Provider Practice Location Address
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Address Line | 677 E MAIN ST STE A
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City | CENTREVILLE
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State | MI
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Zip | 49032-8525
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Country | US
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Telephone | 269-467-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 677 E MAIN ST STE A
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City | CENTREVILLE
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State | MI
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Zip | 49032-8525
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Country | US
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Telephone | 269-467-1000
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | CAMERON EDWARD BREWSTER BULLOCK
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Credential |
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Telephone | 269-467-1001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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