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General NPI Number Information
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NPI Number | 1760818827
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Entity Type | Organization
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Legal Business Name | BERRIEN MENTAL HEALTH AUTHORITY
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Dates
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Enumeration Date | 09/20/2013
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Last Update Date | 10/05/2018
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Provider Practice Location Address
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Address Line | 1485 M 139
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City | BENTON HARBOR
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State | MI
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Zip | 49022-5711
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Country | US
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Telephone | 269-934-1611
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Fax |
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Provider Business Mailing Address
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Address Line | 1485 M 139
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City | BENTON HARBOR
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State | MI
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Zip | 49022-5711
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Country | US
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Telephone | 269-934-1611
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Fax |
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Authorized Official
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Title or Position | BUSINESS OFFICE MANAGER
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Name | BRETT A LYZENGA
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Credential |
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Telephone | 269-934-1611
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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 |
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License Number State |
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