| Full Name | |
|---|---|
| Speciality | Psychologist |
| Location | Po Box 497, Redlake, Minnesota |
| Authorized Official Name and Position | Janice Marie Thunder (BUSINESS OFFICE MANAGER) |
| Authorized Official Contact | 2186793912 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
24760 Hospital Drive Box 497 C/o Business Office Red Lake MN 56670 Ph: (218) 679-3912 | Po Box 497 Redlake MN 56671-0497 Ph: (218) 679-3912 |
| NPI Number | 1679099568 |
|---|---|
| Provider Enumeration Date | 08/22/2017 |
| Last Update Date | 07/21/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679099568 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | (Minnesota) | Primary |
Red Lake Comprehensive Health Services Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 24760 Hospital Drive, Redlake, MN 56671 Phone: 218-679-3316 Fax: 218-679-3990 | |