Organization Name: | CEDARBROOK COMMUNITY SERVICES |
NPI Number: | 1164488847 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | GERALD JENSEN (EXECUTIVE DIRECTOR) |
Mailing Address: | 8391 College Rd Baxter |
State: | MN US |
Postal Code: | 564258694 |
Phone Number: | 2188223736 |
Fax Number: | |
NPI Enumeration Date: | 04/21/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TB0200X |
License Number: | LP 4642 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MN |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Cognitive & Behavioral |
Taxonomy Definition: |