| Organization Name: | MILLE LACS ACADEMY |
| NPI Number: | 1063773174 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JAN GIBSON TALBOT (EXECUTIVE DIRECTOR) |
| Mailing Address: | 407 130th Ave S Onamia |
| State: | MN US |
| Postal Code: | 563593115 |
| Phone Number: | 3205324005 |
| Fax Number: | |
| NPI Enumeration Date: | 06/05/2012 |
| NPI Last Update Date: | 06/05/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TP0016X |
| License Number: | 1036935-2-CRF |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Prescribing (Medical) |
| Taxonomy Definition: | Those licensed psychologists who have completed specialized, post-doctoral training in psychopharmacology, passed a national proficiency examination in psychopharmacology, and who are authorized by state statute to prescribe medications, in accordance with their state law and state licensing authority, for the evaluation, diagnosis, management and treatment of mental, nervous, emotional, behavioral, and related disorders. |