| Hiawatha Behavioral Health | |
|
3865 S Mackinac Trl Sault Sainte Marie MI 49783-9286 | |
| (906) 632-2805 | |
| (906) 632-1163 |
| Full Name | Hiawatha Behavioral Health |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 3865 S Mackinac Trl, Sault Sainte Marie, Michigan |
| Authorized Official Name and Position | Samuel Harma (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 9063412144 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Hiawatha Behavioral Health 125 N Lake St Manistique MI 49854-1234 Ph: (906) 341-2144 | Hiawatha Behavioral Health 3865 S Mackinac Trl Sault Sainte Marie MI 49783-9286 Ph: (906) 632-2805 |
| NPI Number | 1629161567 |
|---|---|
| Provider Enumeration Date | 10/02/2006 |
| Last Update Date | 11/16/2011 |
| Medicare PECOS PAC ID | 3870509490 |
|---|---|
| Medicare Enrollment ID | O20060306000454 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629161567 | NPI | - | NPPES |
| 7509104110 | Other | MI | BCBS |
| 774361332 | Medicaid | MI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | David Meeker |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1336123520 PECOS PAC ID: 2264414770 Enrollment ID: I20040607000832 |
| Provider Name | Courtney E Grant |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1275771065 PECOS PAC ID: 3476605791 Enrollment ID: I20090717000349 |
| Provider Name | Lynn E Miller |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1659354298 PECOS PAC ID: 7911194857 Enrollment ID: I20101206000043 |
| Provider Name | Lisa Tatrow |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1053624635 PECOS PAC ID: 2163610817 Enrollment ID: I20101221001018 |
| Provider Name | Maria L Baller |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1467752386 PECOS PAC ID: 5496907461 Enrollment ID: I20121221000039 |
| Provider Name | Kerri L Hotlen |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1770925646 PECOS PAC ID: 2860714417 Enrollment ID: I20141210000047 |
| Provider Name | Marija Petrovic |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1225138530 PECOS PAC ID: 9739281700 Enrollment ID: I20170214002631 |
| Provider Name | Goldie Lynn Cooper |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1194275289 PECOS PAC ID: 6305183807 Enrollment ID: I20190122002326 |
| Provider Name | Holly Engle |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1659821775 PECOS PAC ID: 8123369147 Enrollment ID: I20190401000893 |
| Provider Name | Debra Joyce Peake |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1316306590 PECOS PAC ID: 8022341064 Enrollment ID: I20190606002260 |
| Provider Name | Lori Simon |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1699218859 PECOS PAC ID: 6103189568 Enrollment ID: I20190702001056 |
| Provider Name | Austin Mcdonough |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1558544213 PECOS PAC ID: 3072947936 Enrollment ID: I20191231000491 |
| Provider Name | Blaine Janette Yoder |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1154908556 PECOS PAC ID: 3072960624 Enrollment ID: I20231103002247 |
| Provider Name | Debra Thurman Dobbs |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1134458029 PECOS PAC ID: 8921451626 Enrollment ID: I20240130000785 |
| Provider Name | David Nathaniel Frank |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1992226450 PECOS PAC ID: 8123471687 Enrollment ID: I20240131003332 |
| Provider Name | Lori Rachelle Metcalf-rodes |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1386168854 PECOS PAC ID: 9537504766 Enrollment ID: I20240228000684 |
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