| Ausable Valley Community Mental Health Services Board | |
|
1199 W Harris Ave Tawas City MI 48764-9310 | |
| (989) 362-8636 | |
| Not Available |
| Full Name | Ausable Valley Community Mental Health Services Board |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 1199 W Harris Ave, Tawas City, Michigan |
| Authorized Official Name and Position | Floyd Smith (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 9893628636 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ausable Valley Community Mental Health Services Board 1199 W Harris Ave Po Box 310 Tawas City MI 48764-9310 Ph: (989) 362-8636 | Ausable Valley Community Mental Health Services Board 1199 W Harris Ave Tawas City MI 48764-9310 Ph: (989) 362-8636 |
| NPI Number | 1417011701 |
|---|---|
| Provider Enumeration Date | 12/20/2006 |
| Last Update Date | 06/08/2010 |
| Medicare PECOS PAC ID | 2961485610 |
|---|---|
| Medicare Enrollment ID | O20050421000668 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417011701 | NPI | - | NPPES |
| 4456570 | Medicaid | MI | |
| 1706830 | Medicaid | MI | |
| 4811060 | Medicaid | MI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Ali E Ibrahim |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1710089388 PECOS PAC ID: 1658349212 Enrollment ID: I20040921001007 |
| Provider Name | Rudy A Barba |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1831280569 PECOS PAC ID: 8820031867 Enrollment ID: I20050609000936 |
| Provider Name | Mary Holbrook |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508205451 PECOS PAC ID: 6103050414 Enrollment ID: I20130927000474 |
| Provider Name | Wendy Vatter |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1972773497 PECOS PAC ID: 1254560162 Enrollment ID: I20140218000843 |
| Provider Name | Rosalind A Spells |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1841311552 PECOS PAC ID: 1557309770 Enrollment ID: I20150810000291 |
| Provider Name | Jami L Akins |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1174902357 PECOS PAC ID: 1759621550 Enrollment ID: I20190313002893 |
| Provider Name | Mary B Jameson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1992106702 PECOS PAC ID: 9739414228 Enrollment ID: I20190703002210 |
| Provider Name | Trudi Lynn Marsh |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1386957355 PECOS PAC ID: 7911234091 Enrollment ID: I20190813000093 |
| Provider Name | Cynthia Lynn Mai |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720606098 PECOS PAC ID: 7416371349 Enrollment ID: I20200723003042 |
| Provider Name | Nancy Boyett |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1629170055 PECOS PAC ID: 7517017049 Enrollment ID: I20221013002474 |
| Provider Name | Daria Datnoff |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1356957070 PECOS PAC ID: 8123426640 Enrollment ID: I20221018002495 |
| Provider Name | Terry Lynn Shirley |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1407148364 PECOS PAC ID: 6608113923 Enrollment ID: I20230303001086 |
| Provider Name | Shane T Whalen |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1457715310 PECOS PAC ID: 8729407838 Enrollment ID: I20230407001397 |
| Provider Name | Sharon Walden |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1700221066 PECOS PAC ID: 2264899624 Enrollment ID: I20230531001881 |
| Provider Name | Melissa Wazny |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114707445 PECOS PAC ID: 4486009958 Enrollment ID: I20231018003392 |
| Provider Name | Iesha Rodriguez |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1609377159 PECOS PAC ID: 6800214339 Enrollment ID: I20231127000544 |
| Provider Name | Jessica Cox |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1871161349 PECOS PAC ID: 0941602304 Enrollment ID: I20240119002823 |
| Provider Name | Megan Cathleen Savasky |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1992173256 PECOS PAC ID: 5991157489 Enrollment ID: I20240119003811 |
| Provider Name | Jeri Lynn Crouterfield |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1497107445 PECOS PAC ID: 8527410018 Enrollment ID: I20240119003824 |
| Provider Name | Lindsey Voss |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1447977848 PECOS PAC ID: 7911350954 Enrollment ID: I20240126000313 |
| Provider Name | Shanda Berdan |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1407252133 PECOS PAC ID: 2062865009 Enrollment ID: I20240126000471 |
| Provider Name | Benjamin Chauncey Wiltse |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1538618095 PECOS PAC ID: 9335592203 Enrollment ID: I20240126001583 |
| Provider Name | Kalee Koronka |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1982207924 PECOS PAC ID: 4688017650 Enrollment ID: I20240206004251 |
| Provider Name | Ashley Nicole Ross |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1730572025 PECOS PAC ID: 2466824354 Enrollment ID: I20240322001547 |