Provider Demographics
NPI:1861430381
Name:BRANCH COUNTY COMMUNITY MENTAL HEALTH AUTHORITY
Entity type:Organization
Organization Name:BRANCH COUNTY COMMUNITY MENTAL HEALTH AUTHORITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FINANCE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROBBIN
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:WILBER
Authorized Official - Suffix:
Authorized Official - Credentials:BBA
Authorized Official - Phone:517-278-2129
Mailing Address - Street 1:200 VISTA DR
Mailing Address - Street 2:
Mailing Address - City:COLDWATER
Mailing Address - State:MI
Mailing Address - Zip Code:49036-1776
Mailing Address - Country:US
Mailing Address - Phone:517-278-2129
Mailing Address - Fax:517-279-8172
Practice Address - Street 1:200 VISTA DR
Practice Address - Street 2:
Practice Address - City:COLDWATER
Practice Address - State:MI
Practice Address - Zip Code:49036
Practice Address - Country:US
Practice Address - Phone:517-278-2129
Practice Address - Fax:517-279-8172
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRANCH COUNTY COMMUNITY MENTAL HEALTH AUTHORITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-04
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI75-09-10497OtherBCBS
MI774352834Medicaid
MIOP20060Medicare PIN