Basic Information
| Provider Information | |||||||||
| NPI: | 1841474251 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTHLAND COUNSELING CENTER, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 215 SE 2ND AVE | ||||||||
| Address2: | CASE MANAGEMENT | ||||||||
| City: | GRAND RAPIDS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 557443615 | ||||||||
| CountryCode: | US | ||||||||
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| Address1: | 215 SE 2ND AVE | ||||||||
| Address2: | CASE MANAGEMENT | ||||||||
| City: | GRAND RAPIDS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 557443615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2183271151 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/20/2007 | ||||||||
| LastUpdateDate: | 12/20/2007 | ||||||||
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| AuthorizedOfficialLastName: | MADSEN | ||||||||
| AuthorizedOfficialFirstName: | CATHY | ||||||||
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| AuthorizedOfficialTitleorPosition: | AR SUPERVISOR | ||||||||
| AuthorizedOfficialTelephone: | 2183271151 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251B00000X | Y | Agencies | Case Management |
No ID Information.