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NPI Code Detail

MEDICARE: BLUE WATER MENTAL HEALTH CLINIC

MEDICARE: BLUE WATER MENTAL HEALTH CLINIC
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
1103TC0700XClinical Psychologist
21041C0700XClinical Social Worker
3101YP2500XProfessional Counselor
4106H00000XMarriage & Family Therapist
52084P0800XPsychiatry Physician
6261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number : 1457305419
Entity Type Code : Organization
Provider Name (Legal Business Name) : BLUE WATER MENTAL HEALTH CLINIC
Provider Business Mailing Address
First Line : 1501 KRAFFT RD
Second Line :
City : FORT GRATIOT
State : MI
Zip : 48059-3565
Country : US
Telephone Number : 810-985-5125
Fax Number : 810-985-5127
Provider Business Practice Location Address
First Line : 1501 KRAFFT RD
Second Line :
City : FORT GRATIOT
State : MI
Zip : 48059-3565
Country : US
Telephone Number : 810-985-5125
Fax Number : 810-985-5127
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : MRS. LINDA A LIETHEN
Credential : LLP
Telephone Number : 810-985-5125
Provider Enumeration Date : 05/22/2006
Last Update Date : 11/29/2016

Similar Medicare Providers

1912010315 — MS. KAREN BRICKNER M.A.
Practice Location Address:
1501 KRAFFT RD
FORT GRATIOT, MI
48059-3565
Practice Phone: 810-985-5125
Practice Fax:
1609820737 — DR. MARIO ROBERTO LANNI M.D.
Practice Location Address:
1501 KRAFFT RD
FORT GRATIOT, MI
48059-3565
Practice Phone: 810-985-5125
Practice Fax: 810-985-5127
1578590576 — SUSAN ARTH LMFT
Practice Location Address:
1501 KRAFFT RD
FORT GRATIOT, MI
48059-3565
Practice Phone: 810-985-5125
Practice Fax: 810-985-5127
1245263474 — AMY FABICK MSW
Practice Location Address:
1501 KRAFFT RD
FORT GRATIOT, MI
48059-3565
Practice Phone: 810-985-5125
Practice Fax: 810-985-5127
1871526277 — ELIZABETH A VARTY LPC
Practice Location Address:
1501 KRAFFT RD
FORT GRATIOT, MI
48059-3565
Practice Phone: 810-985-5125
Practice Fax: 810-985-5127
1982638805 — LEELA CHERIAN PHD, LLP
Practice Location Address:
1501 KRAFFT RD
FORT GRATIOT, MI
48059-3565
Practice Phone: 810-985-5125
Practice Fax: 810-985-5127

Directions to “BLUE WATER MENTAL HEALTH CLINIC ” Practice Location

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