| Organization Name: | BOOSHKE MENTAL HEALTH INC. |
| NPI Number: | 1063464824 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MELISSA ANN GEORGE-HUMPHREY (MENTAL HEALTH PROFESSIONAL) |
| Mailing Address: | 522 Beltrami Ave Nw Ste 116 Bemidji |
| State: | MN US |
| Postal Code: | 566013002 |
| Phone Number: | 2187602222 |
| Fax Number: | 2184447105 |
| NPI Enumeration Date: | 05/17/2006 |
| NPI Last Update Date: | 05/11/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 14486 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |