Midwest Behavioral Center

Primary specialty

Early Intervention Provider AgencyTaxonomy code 252Y00000X

Legal business name

MIDWEST BEHAVIORAL CENTER

Practice address

119 24TH Ave S
Waite Park, MN 56387-2025

Phone

(612) 226-4860

NPI assigned

Sep 9, 2020

Last updated

Sep 9, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mukhtar O Hud

Title

Owner

Phone

(612) 226-4860

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1599609600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1599609600000",
    "number": "1124633961",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "119 24TH AVE S",
            "city": "WAITE PARK",
            "state": "MN",
            "postal_code": "563872025",
            "telephone_number": "612-226-4860"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "119 24TH AVE S",
            "city": "WAITE PARK",
            "state": "MN",
            "postal_code": "563872025",
            "telephone_number": "612-226-4860"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDWEST BEHAVIORAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-09",
        "last_updated": "2020-09-09",
        "certification_date": "2020-09-09",
        "status": "A",
        "authorized_official_last_name": "HUD",
        "authorized_official_first_name": "MUKHTAR",
        "authorized_official_middle_name": "O",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "612-226-4860"
    },
    "taxonomies": [
        {
            "code": "252Y00000X",
            "taxonomy_group": "",
            "desc": "Early Intervention Provider Agency",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tracie Lynn Melville
• Bryce Mergens, MS
• Darrell K Metcalf, DC
• Alexandra Meyer, DC
• Cynthia Leann Mickelson, BA, MOTR/L
• Midwest Medical Holdings LLC (Freedom Medical)
• Alexandra Leigh Miller
• Jennifer Lynne Miller, PH.D., LP
• Owen Christopher Miller
• Rebecca Anne Miller, AGNP-C

• Early Intervention Provider Agency in Waite Park, MN
• Providers in Waite Park, MN by specialty
• Early Intervention Provider Agency in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.