Healthcare Provider Details

I. General information

NPI: 1811169337
Provider Name (Legal Business Name): WHITE EARTH TRIBAL MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2008
Last Update Date: 03/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35686 COUNTY HWY 21
WHITE EARTH MN
56591-0300
US

IV. Provider business mailing address

35686 COUNTY HWY. 21
WHITE EARTH MN
56591-0300
US

V. Phone/Fax

Practice location:
  • Phone: 218-983-3285
  • Fax: 218-983-4236
Mailing address:
  • Phone: 218-983-3285
  • Fax: 218-983-4236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number3181
License Number StateND

VIII. Authorized Official

Name: JOELLEN ANYWAUSH
Title or Position: HEALTH DIRECTOR
Credential:
Phone: 218-983-3285