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1000 8th St Se Ste A Detroit Lakes MN 56501-2819 | |
| (218) 847-0696 | |
| (218) 847-4198 |
| Full Name | |
|---|---|
| Speciality | Counselor - Addiction (substance Use Disorder) |
| Location | 1000 8th St Se, Detroit Lakes, Minnesota |
| Authorized Official Name and Position | Jessica Rae Moench (OWNER/DIRECTOR) |
| Authorized Official Contact | 2183960288 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1000 8th St Se Ste A Detroit Lakes MN 56501-2819 Ph: (218) 847-0696 | 1000 8th St Se Ste A Detroit Lakes MN 56501-2819 Ph: (218) 847-0696 |
| NPI Number | 1861497190 |
|---|---|
| Provider Enumeration Date | 06/14/2005 |
| Last Update Date | 12/10/2024 |
| Certification Date | 12/04/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861497190 | NPI | - | NPPES |
| 903109000 | Medicaid | MN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Primary |
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