Basic Information
| Provider Information | |||||||||
| NPI: | 1265483457 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COMMUNITY MENTAL HEALTH AUTHORITY OF CLINTON EATON INGHAM COUNTIES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 812 E JOLLY ROAD | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 489106821 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5173468119 | ||||||||
| FaxNumber: | 5173468291 | ||||||||
| Practice Location | |||||||||
| Address1: | 812 E JOLLY ROAD | ||||||||
| Address2: | |||||||||
| City: | LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 489106821 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5173468200 | ||||||||
| FaxNumber: | 5173468291 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/13/2006 | ||||||||
| LastUpdateDate: | 03/11/2020 | ||||||||
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| AuthorizedOfficialLastName: | LURIE | ||||||||
| AuthorizedOfficialFirstName: | SARA | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 5173468212 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 03/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0801X | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
ID Information
| ID | Type | State | Issuer | Description | 21-1708001 | 05 | MI | MEDICAID |