NPIMap

Organization Active NPI

St Clair County Community Mental Health Authority

  • Community/Behavioral Health Agency
  • Port Huron, MI
National Provider Identifier
1689783672
Registry record updated Jun 12, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
ST CLAIR COUNTY COMMUNITY MENTAL HEALTH AUTHORITY
Practice address
3111 Electric Ave
Port Huron, MI 48060-8127
Phone
(810) 985-8900
NPI assigned
Aug 30, 2006
Last updated
Jun 12, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 12, 2025

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

Authorized official

Name
Debra B. Johnson
Title
Executive Director
Phone
(810) 985-8900

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

3111 Electric Ave
Port Huron, MI 48060-8127

Mailing address

3111 Electric Avenue
Port Huron, MI 48060-8127
Phone (810) 985-8900

Other identifiers 2

IdentifierTypeStateIssuer
1708164MedicaidMI
4349015MedicaidMI

Other names 1

  • St. Clair County Community Mental Health Authority Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI4 enrollments

Enrollment records 4

Enrollment IDStateProvider typePAC IDDetails
O20031118000783 MI Part B Supplier - Clinic/Group Practice 7416861984 Receives reassigned benefits from 79 practitioners
3 other NPIs on this enrollment
Practice locations: Marine City, MI; Mussey, MI; Port Huron, MI
O20040209000604 MI Part B Supplier - Clinic/Group Practice 7416861984 Receives reassigned benefits from 6 practitioners
3 other NPIs on this enrollment
Practice locations: Mussey, MI; Port Huron, MI; Marine City, MI
O20040831000305 MI Part B Supplier - Clinic/Group Practice 7416861984 Receives reassigned benefits from 4 practitioners
3 other NPIs on this enrollment
Practice locations: Marine City, MI; Mussey, MI; Port Huron, MI
O20040901000060 MI Part B Supplier - Clinic/Group Practice 7416861984 Receives reassigned benefits from 4 practitioners
3 other NPIs on this enrollment
Practice locations: Marine City, MI; Mussey, MI; Port Huron, MI

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

14675 Downey Rd
Mussey, MI 48014
Phone (810) 395-4343

Practitioners & affiliated clinicians

Practitioners 94

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.

View all 94

NPI Registry JSON

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1749686400000",
    "number": "1689783672",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3111 ELECTRIC AVENUE",
            "city": "PORT HURON",
            "state": "MI",
            "postal_code": "480608127",
            "telephone_number": "810-985-8900",
            "fax_number": "810-985-7620"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3111 ELECTRIC AVE",
            "city": "PORT HURON",
            "state": "MI",
            "postal_code": "480608127",
            "telephone_number": "810-985-8900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST CLAIR COUNTY COMMUNITY MENTAL HEALTH AUTHORITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-30",
        "last_updated": "2025-06-12",
        "certification_date": "2025-06-12",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_middle_name": "B.",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "810-985-8900"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1708164",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4349015",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St. Clair County Community Mental Health Authority",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Port Huron, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2025; 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.