Active NPI
Susan Annette Neuttila, ALCOHOL DRUG COUNSEL
- Addiction (Substance Use Disorder) Counselor
- Virgina, MN
National Provider Identifier
1194826586
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 300410
- Practice address
- 626 S 13TH St
Detox Range Treatment Center
Virgina, MN 55792 - Phone
- (218) 741-9120
- Fax
- (218) 741-3170
- NPI assigned
- Sep 26, 2006
- Last updated
- Jul 8, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 300410 | MN | Primary |
Addresses
Primary practice location
626 S 13TH St
Detox Range Treatment Center
Virgina, MN 55792
Mailing address
626 S 13TH St
Detox Range Treatment Center
Virgina, MN 55792
Phone (218) 741-9120
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 300410 | MN | MD | Addiction (Substance Use Disorder) Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Range Mental Health Center Inc | Past | Accepting new patients | |
| Range Mental Health Center Inc | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Range Treatment Center
- Substance Abuse Rehabilitation Facility
- Virginia, MN
- NPI 1346318193
-
dba Detox
- Substance Abuse Rehabilitation Facility
- Virginia, MN
- NPI 1851419345
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159228800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1194826586",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "626 S 13TH ST",
"address_2": "DETOX RANGE TREATMENT CENTER",
"city": "VIRGINA",
"state": "MN",
"postal_code": "55792",
"telephone_number": "218-741-9120",
"fax_number": "218-741-3170"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "626 S 13TH ST",
"address_2": "DETOX RANGE TREATMENT CENTER",
"city": "VIRGINA",
"state": "MN",
"postal_code": "55792",
"telephone_number": "218-741-9120",
"fax_number": "218-741-3170"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NEUTTILA",
"first_name": "SUSAN",
"middle_name": "ANNETTE",
"credential": "ALCOHOL DRUG COUNSEL",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-26",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "MN",
"license": "300410",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.