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General NPI Number Information
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NPI Number | 1447817978
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Entity Type | Organization
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Legal Business Name | MESABACARE LLC
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Dates
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Enumeration Date | 05/21/2019
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Last Update Date | 06/11/2019
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Provider Practice Location Address
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Address Line | 405 W 3RD AVE N
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City | AURORA
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State | MN
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Zip | 55705-1247
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Country | US
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Telephone | 218-290-7301
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Fax |
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Provider Business Mailing Address
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Address Line | 315 BRANDON RD
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City | HOYT LAKES
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State | MN
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Zip | 55750-1203
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Country | US
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Telephone | 218-290-7301
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Fax |
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Authorized Official
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Title or Position | OWNER/COUNSELOR
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Name | DR. CHAD SAMUEL SCOTT
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Credential | PH.D., LPCC
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Telephone | 218-290-7301
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YS0200X
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Taxonomy Name | School Counselor
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License Number |
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License Number State |
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