NPIMap

Organization Active NPI

Jesola Inc

Doing business as Lakes Counseling Center

  • Addiction (Substance Use Disorder) Counselor
  • Detroit Lakes, MN
National Provider Identifier
1861497190
Registry record updated Dec 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X
Legal business name
JESOLA INC
Doing business as
Lakes Counseling Center
Practice address
1000 8TH St SE
Ste a
Detroit Lakes, MN 56501-2819
Phone
(218) 847-0696
Fax
(218) 847-4198
NPI assigned
Jun 14, 2005
Last updated
Dec 10, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 10, 2024

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

Authorized official

Name
Jessica Rae Moench, BS, LADCNPI 1104132505
Title
Owner/Director
Phone
(218) 396-0288

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X NU Primary

Addresses

Primary practice location

1000 8TH St SE
Ste a
Detroit Lakes, MN 56501-2819

Mailing address

1000 8TH St SE
Ste a
Detroit Lakes, MN 56501-2819
Phone (218) 847-0696

Other identifiers 1

IdentifierTypeStateIssuer
903109000MedicaidMN

Other names 1

  • Lakes Counseling Center Doing business as

National Provider Directory

National Provider Directory

Locations

1000 8th St SE
Detroit Lakes, MN 56501
Phone (218) 847-0696

1000 8th St SE
Ste A
Detroit Lakes, MN 56501
Phone (218) 847-0696

Practitioners & affiliated clinicians

Practitioners 9

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": "1118707200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733788800000",
    "number": "1861497190",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 8TH ST SE",
            "address_2": "STE A",
            "city": "DETROIT LAKES",
            "state": "MN",
            "postal_code": "565012819",
            "telephone_number": "218-847-0696",
            "fax_number": "218-847-4198"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 8TH ST SE",
            "address_2": "STE A",
            "city": "DETROIT LAKES",
            "state": "MN",
            "postal_code": "565012819",
            "telephone_number": "218-847-0696",
            "fax_number": "218-847-4198"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JESOLA INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-14",
        "last_updated": "2024-12-10",
        "certification_date": "2024-12-04",
        "status": "A",
        "authorized_official_last_name": "MOENCH",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_middle_name": "RAE",
        "authorized_official_title_or_position": "OWNER/DIRECTOR",
        "authorized_official_telephone_number": "218-396-0288",
        "authorized_official_credential": "BS, LADC"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "903109000",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lakes Counseling Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Detroit Lakes, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2024; 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.