Provider Demographics
NPI:1386969996
Name:NEWAYGO COUNTY MENTAL HEALTH BOARD
Entity type:Organization
Organization Name:NEWAYGO COUNTY MENTAL HEALTH BOARD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:SNYDER
Authorized Official - Suffix:
Authorized Official - Credentials:ACSW
Authorized Official - Phone:231-689-7330
Mailing Address - Street 1:1049 E NEWELL ST # 867
Mailing Address - Street 2:
Mailing Address - City:WHITE CLOUD
Mailing Address - State:MI
Mailing Address - Zip Code:49349-8795
Mailing Address - Country:US
Mailing Address - Phone:231-689-7330
Mailing Address - Fax:231-689-7345
Practice Address - Street 1:1049 E NEWELL ST
Practice Address - Street 2:
Practice Address - City:WHITE CLOUD
Practice Address - State:MI
Practice Address - Zip Code:49349-8795
Practice Address - Country:US
Practice Address - Phone:231-689-7330
Practice Address - Fax:231-689-7345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-07
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010456692084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1708066Medicaid
MI700F260140OtherBLUE CROSS/BLUE SHIELD
MIP47070002OtherMEDICARE PTAN
MI4892416Medicaid
MI4359826Medicaid
MIP57070001OtherMEDICARE PTAN
MI1417139692OtherNPI - DR. ALT
MIOP57070Medicare PIN