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General NPI Number Information
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NPI Number | 1962549022
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Entity Type | Organization
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Legal Business Name | UPPER SIOUX COMMUNITY
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Dates
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Enumeration Date | 01/30/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5744 HWY 67
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City | GRANITE FALLS
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State | MN
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Zip | 56241
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Country | US
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Telephone | 320-564-2360
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Fax | 320-564-2550
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Provider Business Mailing Address
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Address Line | PO BOX 147
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City | GRANITE FALLS
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State | MN
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Zip | 56241-0147
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Country | US
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Telephone | 320-564-2360
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Fax | 320-564-2550
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Authorized Official
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Title or Position | CD COUNSELOR
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Name | JOE WHITEHAWK
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Credential | LCDC
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Telephone | 320-564-6356
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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 | 301298
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License Number State | MN
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