Healthcare Provider Details

I. General information

NPI: 1861647174
Provider Name (Legal Business Name): NEXT STEP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2008
Last Update Date: 12/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 6TH ST NE
STAPLES MN
56479-2431
US

IV. Provider business mailing address

201 6TH ST NE
STAPLES MN
56479-2431
US

V. Phone/Fax

Practice location:
  • Phone: 218-894-0034
  • Fax: 218-894-0035
Mailing address:
  • Phone: 218-894-0034
  • Fax: 218-894-0035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number1051980
License Number StateMN

VIII. Authorized Official

Name: MRS. JULIE A NELSON
Title or Position: EXECUTIVE DIRECTOR
Credential: LMFT LADC
Phone: 218-894-0034