NPIMap

Organization Active NPI

Central Minnesota Mental Health Center

  • Addiction (Substance Use Disorder) Counselor
  • Monticello, MN
National Provider Identifier
1407977481
Registry record updated Dec 16, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X
License
1022869-2-CDT Issued in MN
Legal business name
CENTRAL MINNESOTA MENTAL HEALTH CENTER
Practice address
407 Washington St
Monticello, MN 55362-8815
Phone
(763) 295-4001
Fax
(763) 295-5086
NPI assigned
Apr 3, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 16, 2010

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

Authorized official

Name
David Baraga, PH.D, LP
Title
Executive Director
Phone
(320) 202-2033

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YA0400X 1022869-2-CDT MN Primary

Addresses

Primary practice location

407 Washington St
Monticello, MN 55362-8815

Mailing address

1321 13TH St N
Saint Cloud, MN 56303-2613
Phone (320) 252-5010

Other identifiers 1

IdentifierTypeStateIssuer
764442600OtherMNPROVIDER NUMBER

Other names 1

  • CD Services-Monticello Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040119000248 MN Part B Supplier - Clinic/Group Practice 4486555877 Receives reassigned benefits from 47 practitioners
12 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Monticello, MN; Waite Park, MN; Saint Cloud, MN; Elk River, MN; Buffalo, MN

Other NPIs on the same Medicare enrollment 12

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

411 3rd St N
Waite Park, MN 56387
Phone (320) 202-2037

NPI Registry JSON

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

{
    "created_epoch": "1175558400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1292457600000",
    "number": "1407977481",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1321 13TH ST N",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563032613",
            "telephone_number": "320-252-5010",
            "fax_number": "320-203-1855"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "407 WASHINGTON ST",
            "city": "MONTICELLO",
            "state": "MN",
            "postal_code": "553628815",
            "telephone_number": "763-295-4001",
            "fax_number": "763-295-5086"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL MINNESOTA MENTAL HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-03",
        "last_updated": "2010-12-16",
        "status": "A",
        "authorized_official_last_name": "BARAGA",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "320-202-2033",
        "authorized_official_credential": "PH.D, LP"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MN",
            "license": "1022869-2-CDT",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROVIDER NUMBER",
            "identifier": "764442600",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CD Services-Monticello",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Monticello, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.