Organization Name: | CENTRAL MINNESOTA MENTAL HEALTH CENTER |
NPI Number: | 1114048170 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DAVID BARAGA (EXECUTIVE DIRECTOR) |
Mailing Address: | 730 Dodge Ave Nw Suite 101 Elk River |
State: | MN US |
Postal Code: | 553301926 |
Phone Number: | 7634413770 |
Fax Number: | 7634419057 |
NPI Enumeration Date: | 04/03/2007 |
NPI Last Update Date: | 07/21/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | 809836-3-CDT |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MN |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |