Leech Lake Outpatient Treatment Program
Organization Active NPI Addiction (Substance Use Disorder) Counselor · Cass Lake, MN
NPI 1275701666 · NPPES record last updated Jul 18, 2008
Key facts
- NPI
- 1275701666
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Addiction (Substance Use Disorder) Counselor 101YA0400X
- Legal business name
- LEECH LAKE OUTPATIENT TREATMENT PROGRAM
- Practice address
- 6095 161St Ave NW
Cass Lake, MN 56633-3428 - Phone
- (218) 335-8308
- Fax
- (218) 335-8307
- NPI assigned
- Feb 19, 2008
- Organization subpart
- Yes
- Parent organization (as reported)
- LEECH LAKE BAND OF OJIBWE
Authorized official
- Name
- Ms. Gloria Mellado
- Title
- A & D Program Director
- Phone
- (218) 335-3567
Corporate family (same tax ID) 18
Practitioners 1
-
Robert Jaspers, ADC-1
National Provider Directory
- Tax ID family
- Leech Lake Opiate Treatment Center
- Part of
- Leech Lake Opiate Treatment Center
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor |
101YA0400X | Yes |
Addresses
Primary practice location
6095 161St Ave NW
Cass Lake, MN 56633-3428
Mailing address
6905 161St St. NW
Cass Lake, MN 56633-3428
Phone (218) 335-8308
Other providers in Cass Lake, MN
- Leech Lake Band of Ojibwe
- Leech Lake Band of Ojibwe
- Leech Lake Opiate Treatment Center
- Leech Lake Opiate Treatment Program
- Leech Lake Opiate Treatment Program
- Leech Lake Reservation
- Leech Lake Tribal Council
- Leech Lake Tribal Council
- Leech Lake Tribal Council
- Leech Lake Tribal Council
All providers in Cass Lake, MN · Addiction (Substance Use Disorder) Counselor in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 18, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.