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General NPI Number Information
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NPI Number | 1700293867
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Entity Type | Organization
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Legal Business Name | DIMENSIONS IN RECOVERY II
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Dates
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Enumeration Date | 07/21/2014
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Last Update Date | 07/21/2014
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Provider Practice Location Address
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Address Line | 13637 60TH ST SW
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City | COKATO
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State | MN
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Zip | 55321-4210
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Country | US
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Telephone | 612-267-2493
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 308
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City | MAPLE LAKE
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State | MN
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Zip | 55358-0308
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Country | US
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Telephone | 612-501-1197
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | JUDITH FEENSTRA
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Credential | MS
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Telephone | 612-501-1197
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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 | 1074026
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License Number State | MN
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