| Community Mental Health And Substance Abuse Services Of St Joseph Coun | |
|
677 E Main St Ste A Centreville MI 49032-8525 | |
| (269) 467-1000 | |
| (269) 467-3075 |
| Full Name | Community Mental Health And Substance Abuse Services Of St Joseph Coun |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 677 E Main St Ste A, Centreville, Michigan |
| Authorized Official Name and Position | Cameron Bullock (CEO) |
| Authorized Official Contact | 2694671001 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Community Mental Health And Substance Abuse Services Of St Joseph Coun 677 E Main St Ste A Centreville MI 49032-8525 Ph: (269) 467-1000 | Community Mental Health And Substance Abuse Services Of St Joseph Coun 677 E Main St Ste A Centreville MI 49032-8525 Ph: (269) 467-1000 |
| NPI Number | 1366438483 |
|---|---|
| Provider Enumeration Date | 09/23/2005 |
| Last Update Date | 05/31/2023 |
| Certification Date | 05/31/2023 |
| Medicare PECOS PAC ID | 9032178496 |
|---|---|
| Medicare Enrollment ID | O20041011000172 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366438483 | NPI | - | NPPES |
| 1708146 | Medicaid | MI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Vicky L Merrills |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1528167392 PECOS PAC ID: 3678753159 Enrollment ID: I20110216000208 |
| Provider Name | Michelle K Butkiewicz |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1356762215 PECOS PAC ID: 3678797859 Enrollment ID: I20140609001412 |
| Provider Name | Ruqaiyah S Rogers |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1003236662 PECOS PAC ID: 1254556657 Enrollment ID: I20140626002220 |
| Provider Name | Alyssia J Moord |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1902152945 PECOS PAC ID: 3375802507 Enrollment ID: I20180117000235 |
| Provider Name | Gagandeep Singh Rana |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1942628862 PECOS PAC ID: 8921380957 Enrollment ID: I20180806001844 |
| Provider Name | Ryan P Davis |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1588937023 PECOS PAC ID: 1557613023 Enrollment ID: I20181010003150 |
| Provider Name | Grae M Miller |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1013386671 PECOS PAC ID: 2264760362 Enrollment ID: I20190828001064 |
| Provider Name | Prabhjot S Grewal |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578105334 PECOS PAC ID: 8729411319 Enrollment ID: I20191212002408 |
| Provider Name | Garrick A Priebe |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1336630466 PECOS PAC ID: 2062777436 Enrollment ID: I20210330001331 |
| Provider Name | Bradley Baker |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1386207967 PECOS PAC ID: 0749661080 Enrollment ID: I20220720003298 |
| Provider Name | Uriah Marriott |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1578175352 PECOS PAC ID: 7315314606 Enrollment ID: I20221028001757 |
| Provider Name | Jonathan Christian Anthony |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1619589074 PECOS PAC ID: 3870961774 Enrollment ID: I20221128001110 |
| Provider Name | Bridgette Mulvaney |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1720581200 PECOS PAC ID: 6800268707 Enrollment ID: I20230201003150 |
| Provider Name | Heather Ann Teadt |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1407436215 PECOS PAC ID: 8022474717 Enrollment ID: I20230523001379 |
| Provider Name | Holly Jean Lago |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1235781121 PECOS PAC ID: 7618335787 Enrollment ID: I20230621003288 |
| Provider Name | Deana Strudwick |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1982392098 PECOS PAC ID: 1759741846 Enrollment ID: I20230720003757 |
| Provider Name | Matthew Jackson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1922651041 PECOS PAC ID: 6800242645 Enrollment ID: I20231030003447 |
| Provider Name | Anna Marie Farley |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1972965747 PECOS PAC ID: 1850743303 Enrollment ID: I20240119002342 |
| Provider Name | Melissa Taylor |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1225381080 PECOS PAC ID: 6901258466 Enrollment ID: I20240119002522 |
| Provider Name | Amanda Joy Kindig |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1770988545 PECOS PAC ID: 8325490881 Enrollment ID: I20240119002627 |
| Provider Name | Travis Scott Kohl |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1497081723 PECOS PAC ID: 5597118539 Enrollment ID: I20240126000197 |
| Provider Name | Crystal Lafler |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1245797257 PECOS PAC ID: 5698128379 Enrollment ID: I20240130000370 |
| Provider Name | Wendy Ludwig |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1053410829 PECOS PAC ID: 0941653216 Enrollment ID: I20240202001176 |