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General NPI Number Information
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NPI Number | 1376633743
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Entity Type | Organization
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Legal Business Name | ADDICTION COUNSELING TREATMENT SERVICES
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Dates
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Enumeration Date | 10/13/2006
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Last Update Date | 06/13/2008
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Provider Practice Location Address
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Address Line | 112 5TH ST.
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City | GAYLORD
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State | MN
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Zip | 55334
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Country | US
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Telephone | 507-238-2716
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Fax | 507-237-2736
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Provider Business Mailing Address
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Address Line | 112 5TH ST. P.O. BOX 700
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City | GAYLORD
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State | MN
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Zip | 55334
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Country | US
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Telephone | 507-238-2716
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Fax | 507-237-2736
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Authorized Official
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Title or Position | DIRECTOR
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Name | DANIEL J. RUESGEN
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Credential | LADC
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Telephone | 507-237-2716
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 10422051CDT
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License Number State | MN
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