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General NPI Number Information
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NPI Number | 1760615975
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Entity Type | Organization
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Legal Business Name | LIVINGSTON COUNTY COMMUNITY MENTAL HEALTH AUTHORITY
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Dates
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Enumeration Date | 09/03/2009
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Last Update Date | 09/03/2009
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Provider Practice Location Address
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Address Line | 3800 W GRAND RIVER AVE SUITE 109
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City | HOWELL
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State | MI
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Zip | 48855-5513
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Country | US
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Telephone | 248-767-6837
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Fax |
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Provider Business Mailing Address
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Address Line | 2280 E GRAND RIVER AVE
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City | HOWELL
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State | MI
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Zip | 48843-8503
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Country | US
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Telephone | 517-552-7169
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Fax |
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Authorized Official
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Title or Position | ASSOCIATE DIRECTOR OF FINANCE
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Name | MR. GERARD R NOEL
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Credential |
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Telephone | 517-552-7169
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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 | 6801046966
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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