NPIMap

Organization Active NPI

Christian Counseling of Mid Michigan

  • Mental Health Counselor
  • Mt Pleasant, MI
National Provider Identifier
1366879231
Registry record updated Dec 4, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
CHRISTIAN COUNSELING OF MID MICHIGAN
Practice address
904 E Preston Rd
Mount Pleasant, MI 48858-3921
Phone
(989) 317-4664
Fax
(989) 317-3418
NPI assigned
Oct 8, 2013
Last updated
Dec 4, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 4, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Emily DejongNPI 1083042998
Title
Executive Director
Phone
(989) 317-4664

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X Primary
Professional CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP2500X
PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103T00000X
Marriage & Family TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 106H00000X

Addresses

Primary practice location

904 E Preston Rd
Mount Pleasant, MI 48858-3921

Mailing address

904 E Preston Rd
Mount Pleasant, MI 48858-3921
Phone (989) 317-4664

Other names 1

  • Christian Counseling of Mid Michigan Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240229001333 MI Part B Supplier - Clinic/Group Practice 4789029752 Receives reassigned benefits from 2 practitioners
Practice locations: Mt Pleasant, MI

National Provider Directory

National Provider Directory

Locations

304 W Michigan St
Ste 12
Mt Pleasant, MI 48858
Phone (989) 317-4664

904 E Preston Rd
Mt Pleasant, MI 48858
Phone (989) 317-4664

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1381190400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701648000000",
    "number": "1366879231",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "904 E PRESTON RD",
            "city": "MOUNT PLEASANT",
            "state": "MI",
            "postal_code": "488583921",
            "telephone_number": "989-317-4664",
            "fax_number": "989-317-3418"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "904 E PRESTON RD",
            "city": "MOUNT PLEASANT",
            "state": "MI",
            "postal_code": "488583921",
            "telephone_number": "989-317-4664",
            "fax_number": "989-317-3418"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHRISTIAN COUNSELING OF MID MICHIGAN",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-08",
        "last_updated": "2023-12-04",
        "certification_date": "2023-12-04",
        "status": "A",
        "authorized_official_last_name": "DEJONG",
        "authorized_official_first_name": "EMILY",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "989-317-4664",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Christian Counseling of Mid Michigan",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Mt Pleasant, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.