| Ausable Valley Community Mental Health Services Board | |
|
1199 W Harris Ave Tawas City MI 48764-9310 | |
| (989) 362-8636 | |
| Not Available |
| Full Name | Ausable Valley Community Mental Health Services Board |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 1199 W Harris Ave, Tawas City, Michigan |
| Authorized Official Name and Position | Floyd Smith (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 9893628636 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ausable Valley Community Mental Health Services Board 1199 W Harris Ave Po Box 310 Tawas City MI 48764-9310 Ph: (989) 362-8636 | Ausable Valley Community Mental Health Services Board 1199 W Harris Ave Tawas City MI 48764-9310 Ph: (989) 362-8636 |
| NPI Number | 1417011701 |
|---|---|
| Provider Enumeration Date | 12/20/2006 |
| Last Update Date | 06/08/2010 |
| Medicare PECOS PAC ID | 2961485610 |
|---|---|
| Medicare Enrollment ID | O20040611001286 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417011701 | NPI | - | NPPES |
| 4456570 | Medicaid | MI | |
| 1706830 | Medicaid | MI | |
| 4811060 | Medicaid | MI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Daniel Lee Cole |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1205963436 PECOS PAC ID: 6800800038 Enrollment ID: I20060126000881 |
| Provider Name | Nancy K Graves |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1235568379 PECOS PAC ID: 7113147836 Enrollment ID: I20141001001013 |