Healthcare Provider Details

I. General information

NPI: 1912220708
Provider Name (Legal Business Name): CROW RIVER FAMILY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2010
Last Update Date: 03/09/2020
Certification Date: 03/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1521 NORTHWAY DR STE 110
SAINT CLOUD MN
56303-1274
US

IV. Provider business mailing address

1521 NORTHWAY DR STE 110
SAINT CLOUD MN
56303-1274
US

V. Phone/Fax

Practice location:
  • Phone: 320-774-3355
  • Fax: 320-323-3000
Mailing address:
  • Phone: 320-774-3355
  • Fax: 320-323-3000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: KARA WEST
Title or Position: CLINICAL DIRECTOR
Credential: LICSW
Phone: 320-774-3355