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General NPI Number Information
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NPI Number | 1710066253
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Entity Type | Organization
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Legal Business Name | KALAMAZOO COUNTY COMMUNITY MENTAL HEALTH AUTHORITY
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Dates
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Enumeration Date | 11/03/2006
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 615 E CROSSTOWN PKWY
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City | KALAMAZOO
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State | MI
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Zip | 49001-2501
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Country | US
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Telephone | 269-553-7000
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Fax | 269-553-8012
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Provider Business Mailing Address
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Address Line | 2030 PORTAGE ST
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City | KALAMAZOO
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State | MI
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Zip | 49001-3836
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Country | US
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Telephone | 269-553-7000
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Fax | 269-553-8012
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Authorized Official
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Title or Position | DEPUTY DIRECTOR
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Name | MRS. PAT DAVIS
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Credential |
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Telephone | 269-553-8017
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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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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | SA0390177
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License Number State | MI
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