Leech Lake Outpatient Treatment Program

NPI 1275701666 - Counselor - 101YA0400X

NPI Details
NPI 1275701666
Enumeration Date 02/19/2008
Last Updated 07/18/2008
Entity Type Healthcare Provider
Active Over 8 years ago
Authorized Information
Name GLORIA GLORIA
Position A & D PROGRAM DIRECTOR
Phone (218) 335-8308
Fax (218) 335-8307
Practice Location
6095 161ST AVE NW
CASS LAKE MN, 56633-3428, US
Phone (218) 335-8308
Fax (218) 335-8307
Business Location
6905 161ST ST. NW
CASS LAKE MN, 56633-3428, US
Phone (218) 335-8308
Fax (218) 335-8307
Toxanomy
Taxonomy Code 101YA0400X
License State
License Number
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According to our database, Leech Lake Outpatient Treatment Program NPI is 1275701666, taxonomy code is 101YA0400X Leech Lake Outpatient Treatment Program physically located at 6095 161st Ave Nw, Cass Lake MN, 56633-3428. NPI Number 1033115704 has the healthcare provider type.

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1275701666 NPI number is provided on an as is basis without warranty of any kind. 1275701666 is maintained by the National Plan & Provider Enumeration System. The contents of Leech Lake Outpatient Treatment Program are for informational purposes only.