BLUE WATER MENTAL HEALTH CLINIC (NPI# 1174924864) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1174924864 |
| Entity Type | Organization |
| Organization Name | BLUE WATER MENTAL HEALTH CLINIC |
| Other Organization Name | BLUE WATER COUNSELING |
| Practice Address |
1501 Krafft Rd Fort Gratiot MI 48059-3565 |
| Practice Telephone | 8109855125 |
| Practice Fax Number | 8109855127 |
| Mailing Telephone | 8109855125 |
| Mailing Fax Number | 8109855127 |
| Enumeration Date | 2014-09-12 |
| Last Update Date | 2014-09-12 |
| Authorized Official Name | LINDA A LIETHEN (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 8109855125 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 103TC0700X |
Psychologist Specialization: Clinical |
Behavioral Health & Social Service Providers | ||
| N | 1041C0700X |
Social Worker Specialization: Clinical |
Behavioral Health & Social Service Providers | ||
| N | 2084P0800X |
Psychiatry & Neurology Specialization: Psychiatry |
Allopathic & Osteopathic Physicians | ||
| Y | 261QM0801X |
Clinic/Center Specialization: Mental Health (Including Community Mental Health Center) |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Blue Water Counseling | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467590406 | Blue Water Mental Health Clinic | Counselor | 16 S Main St, Yale, MI 48097-3316 | 2007-02-02 |
| 1891833810 | Blue Water Mental Health Clinic | Marriage & Family Therapist | 1349 S Rochester Rd, Suite 220, Rochester Hills, MI 48307-3150 | 2007-02-02 |
| 1578601522 | Blue Water Mental Health Clinic | Social Worker | 5590 Main St, Suite 3, Lexington, MI 48450-9386 | 2007-02-02 |
| 1457305419 | Blue Water Mental Health Clinic | Psychologist | 1501 Krafft Rd, Fort Gratiot, MI 48059-3565 | 2006-05-22 |
| Street Address |
1501 KRAFFT RD |
| City | FORT GRATIOT |
| State | MI |
| Zip Code | 48059-3565 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609820737 | Mario Roberto Lanni | Psychiatry & Neurology | 1501 Krafft Rd, Fort Gratiot, MI 48059-3565 | 2006-05-22 |
| 1851930648 | Dayna Vasbinder | Counselor | 1501 Krafft Rd, Fort Gratiot, MI 48059-3565 | 2019-12-27 |
| 1679125363 | Taylor Marie Crossley | Clinical Nurse Specialist | 1501 Krafft Rd, Fort Gratiot, MI 48059-3565 | 2019-07-12 |
| 1023590536 | April Gardner | Social Worker | 1501 Krafft Rd, Fort Gratiot, MI 48059-3565 | 2018-08-30 |
| 1679088850 | Jill Thuston | Nurse Practitioner | 1501 Krafft Rd, Fort Gratiot, MI 48059-3565 | 2017-12-09 |
| 1124471016 | Amy Beck | Social Worker | 1501 Krafft Rd, Fort Gratiot, MI 48059-3565 | 2016-07-15 |
| 1699175232 | Eileen O'meara Jay | Social Worker | 1501 Krafft Rd, Fort Gratiot, MI 48059-3565 | 2014-09-02 |
| 1962819011 | Sara Mchugh | Social Worker | 1501 Krafft Rd, Fort Gratiot, MI 48059-3565 | 2014-07-21 |
| 1689016248 | Kelly Aiello | Counselor | 1501 Krafft Rd, Fort Gratiot, MI 48059-3565 | 2013-07-24 |
| 1881030856 | Kara Bacheller | Counselor | 1501 Krafft Rd, Fort Gratiot, MI 48059-3565 | 2013-05-17 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679096374 | Rebecca Campau | Registered Nurse | 4985 Lakeshore Rd, Fort Gratiot, MI 48059 | 2017-07-25 |
| 1598175481 | David Kelley Sr. | Pharmacist | 4475 24th Ave., Fort Gratiot, MI 48059 | 2014-05-01 |
| 1316110968 | Apheresis and Transfusion Medicine of Port Huron Pllc | Pathology | 4970 Lakeshore Road, Fort Gratiot, MI 48059 | 2008-04-03 |
| 1275754152 | Jennifer Ann Peyerk | Physical Therapist | 3902 Arlington Ave., Fort Gratiot, MI 48059 | 2007-05-01 |
| 1013097278 | Randy John Plonka | Internal Medicine | 5979 Lakeshore, Ft Gratiot, MI 48059 | 2006-10-16 |
| 1881708428 | John Nathan Seppo | Social Worker | 3847 Pine Grove Avenue, Fort Gratiot, MI 48059 | 2006-08-19 |
| 1396756615 | Blue Water Family Dentistry PC | Dentist | 4044 24th Ave, Fort Gratiot, MI 48059 | 2006-08-11 |
| 1720018823 | Minden City Community Healthcare Outreach | Clinic/Center | 28 Deer Creek Drive, Fort Gratiot, MI 48059 | 2006-07-04 |
| 1982103966 | Luke Michael Privette | Physical Therapist | 4351 24th Ave Ste 1, Fort Gratiot, MI 48059 | 2018-02-06 |
| 1194115352 | Rachel Brooks | Chiropractor | 2844 Krafft Rd, Fort Gratiot, MI 48059 | 2015-01-27 |
| Find all providers in zip 48059 | ||||
| Taxonomy Code | 261QM0801X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Mental Health (Including Community Mental Health Center) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174799209 | Renewal Christian Counseling Center Inc | Clinic/Center | 3847 Pine Grove Ave Ste B, Fort Gratiot, MI 48059-4265 | 2008-05-08 |
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| Find all providers with the same taxonomy | ||||
| City | FORT GRATIOT |
| Zip Code | 48059 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.