| Organization Name: | WILLOW LAKE MENTAL HEALTH CENTER |
| NPI Number: | 1063738508 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JEANNE FRTIZ (OWNER) |
| Mailing Address: | 902 Highway 15 S Hutchinson |
| State: | MN US |
| Postal Code: | 553503506 |
| Phone Number: | 3205874127 |
| Fax Number: | 3205873886 |
| NPI Enumeration Date: | 04/08/2010 |
| NPI Last Update Date: | 04/08/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |