Organization
BLUE WATER MENTAL HEALTH CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LINDA A LIETHEN LLP (EXECUTIVE DIRECTOR)
(810) 985-5125
Entity
Organization
Contact information
Practice address
1501 KRAFFT RD, FORT GRATIOT, MI 48059-3565
(810) 985-5125
(810) 985-5127
Mailing address
1501 KRAFFT RD, FORT GRATIOT, MI 48059-3565
(810) 985-5125
(810) 985-5127
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
—
—
103TC0700X
Clinical Psychologist
—
—
1041C0700X
Clinical Social Worker
—
—
106H00000X
Marriage & Family Therapist
—
—
2084P0800X
Psychiatry Physician
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
05/22/2006
Last updated
11/29/2016
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