Melinda Jo Genz, LADC
Individual provider Active NPI Addiction (Substance Use Disorder) Counselor · Outing, MN
NPI 1801421680 · NPPES record last updated Mar 11, 2020
Key facts
- NPI
- 1801421680
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Addiction (Substance Use Disorder) Counselor 101YA0400X
- License
- 305667 (MN)
- Practice address
- 5458 Lake Washburn Rd NE
Outing, MN 56662-4460 - Phone
- (218) 851-7904
- NPI assigned
- Mar 11, 2020
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 305667 | MN | MD | Addiction (Substance Use Disorder) Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 305667 | MN | Yes |
Addresses
Primary practice location
5458 Lake Washburn Rd NE
Outing, MN 56662-4460
Mailing address
5458 Lake Washburn Rd NE
Outing, MN 56662-4460
Phone (218) 851-7904
Other names
- Mindi J Genz
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 11, 2020. 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.