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General NPI Number Information
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NPI Number | 1558878629
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Entity Type | Organization
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Legal Business Name | MINNESOTA GIRLS ACADEMY
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Dates
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Enumeration Date | 01/10/2018
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Last Update Date | 01/10/2018
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Provider Practice Location Address
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Address Line | PO BOX 74
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City | BRICELYN
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State | MN
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Zip | 56014-0074
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Country | US
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Telephone | 507-525-1523
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 74
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City | BRICELYN
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State | MN
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Zip | 56014-0074
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Country | US
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Telephone | 507-525-1523
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Fax |
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Authorized Official
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Title or Position | STAFF
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Name | LAURA SUE BORRIS
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Credential |
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Telephone | 507-525-1523
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number | 1081456-2-CRF
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License Number State | MN
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