NPIMap

Organization Active NPI

Gogebic County Community Mental Health Authority

  • Mental Health Counselor
  • Wakefield, MI
National Provider Identifier
1912957143
Registry record updated Aug 30, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
GOGEBIC COUNTY COMMUNITY MENTAL HEALTH AUTHORITY
Practice address
103 W US Highway 2
Wakefield, MI 49968-9515
Phone
(906) 229-6100
Fax
(906) 229-6191
NPI assigned
May 10, 2006
Last updated
Aug 30, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 30, 2023

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

Authorized official

Name
Mrs. Tess GreenoughNPI 1023204658
Title
C.E.O.
Phone
(906) 229-6100

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X NU Primary
Psychologist 103T00000X NU
Clinical Child & Adolescent Psychologist 103TC2200X NU
Social Worker 104100000X NU
Clinical Social Worker 1041C0700X NU

Addresses

Primary practice location

103 W US Highway 2
Wakefield, MI 49968-9515

Mailing address

103 W US Highway 2
Wakefield, MI 49968-9515
Phone (906) 229-6100

Other identifiers 4

IdentifierTypeStateIssuer
4351265MedicaidMI
750910818OtherMIBLUE CROSS OPC
1708119MedicaidMI
IG027143OtherMIMAGELLAN STATE OF MI GROU

Other names 1

  • Gogebic County Community Mental Health Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20041005000542 MI Part B Supplier - Clinic/Group Practice 9537128608 Receives reassigned benefits from 2 practitioners
Practice locations: Wakefield, MI
O20071127000647 MI Part B Supplier - Clinic/Group Practice 9537128608 Receives reassigned benefits from 7 practitioners
Practice locations: Wakefield, MI

National Provider Directory

National Provider Directory
Tax ID family
Gogebic County Authority4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 15

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 15

NPI Registry JSON

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

{
    "created_epoch": "1147219200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693353600000",
    "number": "1912957143",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "103 W US HIGHWAY 2",
            "city": "WAKEFIELD",
            "state": "MI",
            "postal_code": "499689515",
            "telephone_number": "906-229-6100",
            "fax_number": "906-229-6191"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 W US HIGHWAY 2",
            "city": "WAKEFIELD",
            "state": "MI",
            "postal_code": "499689515",
            "telephone_number": "906-229-6100",
            "fax_number": "906-229-6191"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOGEBIC COUNTY COMMUNITY MENTAL HEALTH AUTHORITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-10",
        "last_updated": "2023-08-30",
        "certification_date": "2023-08-30",
        "status": "A",
        "authorized_official_last_name": "GREENOUGH",
        "authorized_official_first_name": "TESS",
        "authorized_official_title_or_position": "C.E.O.",
        "authorized_official_telephone_number": "906-229-6100",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4351265",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OPC",
            "identifier": "750910818",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1708119",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAGELLAN STATE OF MI GROU",
            "identifier": "IG027143",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Gogebic County Community Mental Health",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Gogebic County Community Mental Health",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Wakefield, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 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.