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201 6th St Ne Staples MN 56479-2431 | |
(218) 894-0034 | |
Not Available |
Full Name | |
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Speciality | Counselor - Addiction (substance Use Disorder) |
Location | 201 6th St Ne, Staples, Minnesota |
Authorized Official Name and Position | Jan J Johnson (DIRECTOR) |
Authorized Official Contact | 2188940034 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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518 2nd Ave Ne Staples MN 56479-2930 Ph: (218) 894-2412 | 201 6th St Ne Staples MN 56479-2431 Ph: (218) 894-0034 |
NPI Number | 1093920951 |
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Provider Enumeration Date | 05/14/2007 |
Last Update Date | 07/16/2008 |
Identifier | Type | State | Issuer |
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1093920951 | NPI | - | NPPES |
437100000 | Other | MN | MHCP |
Taxonomy | Type | License (State) | Status |
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101YA0400X | Counselor - Addiction (substance Use Disorder) | 1039408-1-CDT (Minnesota) | Primary |