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General NPI Number Information
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NPI Number | 1013904051
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Entity Type | Organization
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Legal Business Name | NORTHERN PINES MENTAL HEALTH CENTER, INC.
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Dates
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Enumeration Date | 10/04/2005
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Last Update Date | 09/24/2024
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Provider Practice Location Address
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Address Line | 1906 5TH AVE SE
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City | LITTLE FALLS
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State | MN
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Zip | 56345-3317
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Country | US
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Telephone | 320-632-6647
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Fax | 320-632-9525
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Provider Business Mailing Address
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Address Line | PO BOX 367 1906 5TH AVE SE
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City | LITTLE FALLS
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State | MN
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Zip | 56345-0367
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Country | US
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Telephone | 320-632-6642
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Fax | 320-632-9525
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | LAURA VAUGHN
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Credential |
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Telephone | 320-639-2025
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number | 1001061CDT
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number | 10102841CDT
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License Number State | MN
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Taxonomy #3
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 8017541MHC
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License Number State | MN
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