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General NPI Number Information
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NPI Number | 1629221916
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Entity Type | Organization
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Legal Business Name | COPPER ISLAND BEHAVIORAL HEALTH
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Dates
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Enumeration Date | 10/30/2008
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Last Update Date | 12/12/2008
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Provider Practice Location Address
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Address Line | 810 QUINCY ST
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City | HANCOCK
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State | MI
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Zip | 49930-1903
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Country | US
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Telephone | 906-482-9440
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Fax | 906-482-9440
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Provider Business Mailing Address
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Address Line | 810 QUINCY ST
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City | HANCOCK
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State | MI
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Zip | 49930-1903
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Country | US
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Telephone | 906-482-9440
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Fax | 906-482-9440
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. THOMAS WILLIAM COLLINS
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Credential | LMSW
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Telephone | 906-482-9440
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801062508
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License Number State | MI
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