Healthcare Provider Details

I. General information

NPI: 1710582168
Provider Name (Legal Business Name): MIKKE PAPES MSW, LADC, LGSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2020
Last Update Date: 02/15/2024
Certification Date: 02/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1185 CONCORD ST N STE 426C
SOUTH ST PAUL MN
55075-1188
US

IV. Provider business mailing address

1807 MARKET BLVD # 125
HASTINGS MN
55033-3492
US

V. Phone/Fax

Practice location:
  • Phone: 763-286-5392
  • Fax:
Mailing address:
  • Phone: 763-286-5392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number305806
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number32356
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: