NPIMap

Organization Active NPI

Leech Lake Outpatient Treatment Program

  • Addiction (Substance Use Disorder) Counselor
  • Cass Lake, MN
National Provider Identifier
1275701666
Registry record updated Jul 18, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) CounselorTaxonomy code 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
Last updated
Jul 18, 2008By the provider in NPPES
Organization subpart
Yes
Parent organization
LEECH LAKE BAND OF OJIBWEAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 18, 2008

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

Authorized official

Name
Ms. Gloria Mellado
Title
A & D Program Director
Phone
(218) 335-3567

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YA0400X Primary

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

National Provider Directory

National Provider Directory
Tax ID family
Leech Lake Outpatient Treatment Program19 organizations share this tax ID, including this one
Part of
Leech Lake Outpatient Treatment Program

Other organizations with this tax ID 18

Organizations that report the same tax identification number in the National Provider Directory.

View all 18

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1203379200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1216339200000",
    "number": "1275701666",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6905 161ST ST. NW",
            "city": "CASS LAKE",
            "state": "MN",
            "postal_code": "566333428",
            "telephone_number": "218-335-8308",
            "fax_number": "218-335-8307"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6095 161ST AVE NW",
            "city": "CASS LAKE",
            "state": "MN",
            "postal_code": "566333428",
            "telephone_number": "218-335-8308",
            "fax_number": "218-335-8307"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEECH LAKE OUTPATIENT TREATMENT PROGRAM",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LEECH LAKE BAND OF OJIBWE",
        "enumeration_date": "2008-02-19",
        "last_updated": "2008-07-18",
        "status": "A",
        "authorized_official_last_name": "MELLADO",
        "authorized_official_first_name": "GLORIA",
        "authorized_official_title_or_position": "A & D PROGRAM DIRECTOR",
        "authorized_official_telephone_number": "218-335-3567",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cass Lake, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2008; 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.