MEDICARE: JACKSON-HILLSDALE COMMUNITY MENTAL HEALTH BOARD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063466274
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JACKSON-HILLSDALE COMMUNITY MENTAL HEALTH BOARD

Provider Business Mailing Address
First Line	:	1200 N WEST AVE
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49202-2179
Country	:	US
Telephone Number	:	517-789-1209
Fax Number	:	517-796-4532

Provider Business Practice Location Address
First Line	:	1200 N. WEST AVENUE
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49202
Country	:	US
Telephone Number	:	517-789-1209
Fax Number	:	517-796-4532

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER (CEO)
Name	:	MRS. CASSANDRA WATSON
Credential	:	AGPCNP-BC
Telephone Number	:	517-789-1208

Provider Enumeration Date	:	05/20/2006
Last Update Date	:	02/09/2026

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