St Clair County Community Mental Health Authority

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

ST CLAIR COUNTY COMMUNITY MENTAL HEALTH AUTHORITY

Practice address

6221 King Rd
Marine City, MI 48039-1428

Phone

(810) 765-5010

NPI assigned

Feb 21, 2007

Last updated

Jun 12, 2025By the provider in NPPES

Organization subpart

Yes

Parent organization

ST CLAIR COUNTY COMMUNITY MENTAL HEALTH AUTHORITYAs reported in NPPES

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

Addresses

Other identifiers 2

Other names 1

• St. Clair County Community Mental Health South: Marine City - King Road Other name

Medicare fee-for-service enrollment

Enrolled in MI4 enrollments

Enrollment records 4

Other NPIs on the same Medicare enrollment 2

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

• St Clair County Community Mental Health Authority

  • Community/Behavioral Health Agency
  • Capac, MI
  • NPI 1306981675

  O20031118000783, O20040209000604, O20040831000305, O20040901000060

  Same enrollment
• St Clair County Community Mental Health Authority

  • Community/Behavioral Health Agency
  • Port Huron, MI
  • NPI 1689783672

  O20031118000783, O20040209000604, O20040831000305, O20040901000060

  Same enrollment

Part of

St Clair County Community Mental Health Authority - Sud Services

Locations

Practitioners 130

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.

• Meredith Lee Ambrosiewicz, LMSW

  • Clinical Social Worker
  • Port Huron, MI
  • NPI 1215450994
  NPD
• Kelly Baker, LMSW

  • Clinical Social Worker
  • Port Huron, MI
  • NPI 1346767506
  NPD
• Kevin Pierce Bautel, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Clinton Township, MI
  • NPI 1598428856
  NPD
• Bailey A Bourassa, LLPC

  • Mental Health Counselor
  • Port Huron, MI
  • NPI 1518855949
  NPD
• Jerrod Richard Burgess, LMSW

  • Clinical Social Worker
  • Port Huron, MI
  • NPI 1093186207
  NPD
• Madeline Burke, LMSW, CAADC

  • Clinical Social Worker
  • Port Huron, MI
  • NPI 1700403870
  NPD
• Shannon Marie Conover

  • Clinical Social Worker
  • Port Huron, MI
  • NPI 1376052845
  NPD
• Courtney Cornwall

  • Occupational Therapist
  • Port Huron, MI
  • NPI 1306596457
  NPD
• Laura Dahnke, RDN, CDE

  • Registered Dietitian
  • Port Huron, MI
  • NPI 1457830531
  NPD
• Julia Ashley Daniel, LMSW

  • Clinical Social Worker
  • Port Huron, MI
  • NPI 1275296956
  NPD
• Ann-Marie Daniels-Hillman, LMSW, CAADC

  • Clinical Social Worker
  • Port Huron, MI
  • NPI 1447261821
  NPD
• Madison Dillon, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Port Huron, MI
  • NPI 1619740982
  NPD

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

{
    "created_epoch": "1172016000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1749686400000",
    "number": "1821133265",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3111 ELECTRIC AVE",
            "city": "PORT HURON",
            "state": "MI",
            "postal_code": "480608127",
            "telephone_number": "810-985-8900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6221 KING RD",
            "city": "MARINE CITY",
            "state": "MI",
            "postal_code": "480391428",
            "telephone_number": "810-765-5010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST CLAIR COUNTY COMMUNITY MENTAL HEALTH AUTHORITY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ST CLAIR COUNTY COMMUNITY MENTAL HEALTH AUTHORITY",
        "enumeration_date": "2007-02-21",
        "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": "NU",
            "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 South: Marine City - King Road",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• David Scheel, MA, LPC, LMSW
• Tamara Ghesquiere Shivers, LPC
• SL Counseling, LLP (Ease of Mind Counseling)
• Ricci Danielle Springborn
• St Clair County Community Mental Health Authority
• St Clair County Community Mental Health Authority (St Clair County Community Mental Health SUD Services - Broadway)
• St Clair County Community Mental Health Sud Services - Marine City
• Lisa Stockwell
• Kathy Uppleger
• Mary Jo Ann Walentovic

• Community/Behavioral Health Agency in Marine City, MI
• Providers in Marine City, MI by specialty
• Community/Behavioral Health Agency in Michigan

• 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.