Healthcare Provider Details

I. General information

NPI: 1609869726
Provider Name (Legal Business Name): GREATER MINNESOTA FAMILY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2005
Last Update Date: 08/31/2020
Certification Date: 08/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2320 HIGHWAY 12 E STE 2
WILLMAR MN
56201-5811
US

IV. Provider business mailing address

2320 HIGHWAY 12 E STE 2
WILLMAR MN
56201-5811
US

V. Phone/Fax

Practice location:
  • Phone: 320-214-9692
  • Fax: 320-214-9924
Mailing address:
  • Phone: 320-214-9692
  • Fax: 320-214-9924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number810871-2-MHC
License Number StateMN

VIII. Authorized Official

Name: MR. GEORGE DUBIE
Title or Position: CEO
Credential: MS/LP
Phone: 320-214-9692