=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457742140
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHOICES BEHAVIORAL HEALTH L.L.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/17/2015
-----------------------------------------------------
Last Update Date | 02/17/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 221 S MILL ST
-----------------------------------------------------
City | REDWOOD FALLS
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56283-1683
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 507-616-1113
-----------------------------------------------------
Fax | 507-616-1115
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 292
-----------------------------------------------------
City | REDWOOD FALLS
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56283-0292
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 507-616-1113
-----------------------------------------------------
Fax | 507-616-1115
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MENTAL HEALTH PROFESSIONAL
-----------------------------------------------------
Name | MS. GLORIA ANDREASEN
-----------------------------------------------------
Credential | LICSW
-----------------------------------------------------
Telephone | 507-616-1113
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | 16694
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------