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Organization
COPPER COUNTRY COMMUNITY MENTAL HEALTH SERVICES
Active
Organization
COPPER COUNTRY COMMUNITY MENTAL HEALTH SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LAWRENCE JOHN POLLACK PHD. (EXECUTIVE DIRECTOR)
(906) 482-9400
Entity
Organization
Contact information
Practice address
901 W. MEMORIAL DR., HOUGHTON, MI 49931
(906) 482-9400
(906) 483-0269
Mailing address
901 W. MEMORIAL DR., HOUGHTON, MI 49931
(906) 482-9400
(906) 483-0269
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
21 1707962
—
MI
01
—
750910600
BLUE CROSS
MI
01
—
750910601
BLUE CROSS
MI
01
—
750910603
BLUE CROSS
MI
01
—
750910617
BLUE CROSS
MI
Enumeration date
08/14/2006
Last updated
06/18/2010
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