Provider Demographics
NPI:1851636310
Name:NORTHERN LAKES COMMUNITY MENTAL HEALTH
Entity type:Organization
Organization Name:NORTHERN LAKES COMMUNITY MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:PAFFHOUSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-775-3463
Mailing Address - Street 1:527 COBB ST
Mailing Address - Street 2:
Mailing Address - City:CADILLAC
Mailing Address - State:MI
Mailing Address - Zip Code:49601-2540
Mailing Address - Country:US
Mailing Address - Phone:231-775-3463
Mailing Address - Fax:231-775-1692
Practice Address - Street 1:527 COBB ST
Practice Address - Street 2:
Practice Address - City:CADILLAC
Practice Address - State:MI
Practice Address - Zip Code:49601-2540
Practice Address - Country:US
Practice Address - Phone:231-775-3463
Practice Address - Fax:231-775-1692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-10
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802077661251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management