=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861385270
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALLEGAN COUNTY COMMUNITY MENTAL HEALTH SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/03/2025
-----------------------------------------------------
Last Update Date | 06/26/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 540 JENNER DR
-----------------------------------------------------
City | ALLEGAN
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49010-1517
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 269-673-6617
-----------------------------------------------------
Fax | 269-673-2738
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 540 JENNER DR
-----------------------------------------------------
City | ALLEGAN
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49010-1517
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 269-270-2579
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MARK WITTE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 269-673-6617
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------