Provider Demographics
NPI:1134264435
Name:MACOMB COUNTY COMMUNITY MENTAL HEALTH
Entity type:Organization
Organization Name:MACOMB COUNTY COMMUNITY MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CARE COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLE
Authorized Official - Middle Name:F
Authorized Official - Last Name:COONAN-COX
Authorized Official - Suffix:
Authorized Official - Credentials:RN,MA,LPC
Authorized Official - Phone:586-948-0224
Mailing Address - Street 1:46360 GRATIOT AVE
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48051-2800
Mailing Address - Country:US
Mailing Address - Phone:586-948-0213
Mailing Address - Fax:586-948-0213
Practice Address - Street 1:46360 GRATIOT AVE
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MI
Practice Address - Zip Code:48051-2800
Practice Address - Country:US
Practice Address - Phone:586-948-0224
Practice Address - Fax:586-948-0213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401005800251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6401005800OtherL.P.C.
MI4704063386OtherREGISTERED NURSE