Doctor Name: | DEAN STUART MORTENSON |
NPI Number: | 1194847863 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MA,ADCT |
License Number: | 302476 |
Business Practice Address: | 323 S Minnesota St Crookston, MN - 567161601 |
Business Phone Number: | 2182819436 |
Business Fax Number: | |
Mailing Address: | 323 S Minnesota St, CROOKSTON |
State: | MN |
Postal Code: | 567161601 |
Phone Number: | 2182819436 |
Fax Number: | |
NPI Enumeration Date: | 04/04/2007 |
NPI Last Update Date: | 12/02/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | 302476 |
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: |