Provider Demographics
NPI:1154518652
Name:CONNECTION FOR MENTAL HEALTH,PLC
Entity type:Organization
Organization Name:CONNECTION FOR MENTAL HEALTH,PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:DANENE
Authorized Official - Last Name:CHAMBERLAIN-CLEMENTS
Authorized Official - Suffix:
Authorized Official - Credentials:ACSW, LMSW
Authorized Official - Phone:989-633-9021
Mailing Address - Street 1:200 E MAIN ST STE 200
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-6510
Mailing Address - Country:US
Mailing Address - Phone:989-633-9021
Mailing Address - Fax:989-633-9026
Practice Address - Street 1:200 E MAIN ST STE 200
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-6510
Practice Address - Country:US
Practice Address - Phone:989-633-9021
Practice Address - Fax:989-633-9026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-28
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801017305251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1871661082OtherINDIVIDUAL NPI
MI0P28310Medicare UPIN
MIP28310001Medicare PIN