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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