BLUE WATER MENTAL HEALTH CLINIC NPI 1467590406

NPI Information

NPI: 1467590406
Provider Name: BLUE WATER MENTAL HEALTH CLINIC
Classification: Clinic/Center - 261QM0801X
Entity Type: Organization

Specialization: Mental Health (Including Community Mental Health Center)

CLIA Number: 23D0959661

Address:
16 S MAIN ST
YALE, MI
ZIP 48097
Phone: (810) 985-5125
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BLUE WATER MENTAL HEALTH CLINIC is a mental health (including community mental health center) clinic center in Yale, MI. BLUE WATER MENTAL HEALTH CLINIC NPI is 1467590406. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

16 S MAIN ST
YALE, MI
ZIP 48097-316
Phone: (810) 985-5125
Fax: (810) 985-5127

The provider's authorized official is Linda A. Liethen .
The authorized official title is Executive Director and has the following contact phone number (810) 985-5125.

The CLIA number assigned to this NPI record is 23D0959661 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 2/2/2007 and was last updated on 12/28/2010.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	Primary
1	101YP2500X	Counselor	Professional	No
2	106H00000X	Marriage & Family Therapist		No
3	103TC0700X	Psychologist	Clinical	No
4	1041C0700X	Social Worker	Clinical	No
5	2084P0800X	Psychiatry & Neurology	Psychiatry	No
6	261QM0801X	Clinic/Center	Mental Health (Including Community Mental Health Center)	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	0G46345	MEDICARE PIN
2	0G46321	MEDICARE PIN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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