MEDICARE: GREATER MINNESOTA FAMILY SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	810871-2-MHC	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	030726018	OTHER	MN	PRIMEWEST
2	60144	OTHER	MN	HEALTHPARTNERS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	05Q36GR	OTHER	MN	BLUE CROSS BLUE SHIELD
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	62-54676	OTHER	MN	MEDICA/UBH
8	122230	OTHER	MN	BHP/UCARE

General Provider Information

NPI Number	:	1609869726
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREATER MINNESOTA FAMILY SERVICES

Provider Business Mailing Address
First Line	:	2320 HIGHWAY 12 E STE 2
Second Line	:
City	:	WILLMAR
State	:	MN
Zip	:	56201-5811
Country	:	US
Telephone Number	:	320-214-9692
Fax Number	:	320-214-9924

Provider Business Practice Location Address
First Line	:	2320 HIGHWAY 12 E STE 2
Second Line	:
City	:	WILLMAR
State	:	MN
Zip	:	56201-5811
Country	:	US
Telephone Number	:	320-214-9692
Fax Number	:	320-214-9924

Authorized Official
Title or Position	:	CEO
Name	:	MR. GEORGE DUBIE
Credential	:	MS/LP
Telephone Number	:	320-214-9692

Provider Enumeration Date	:	08/24/2005
Last Update Date	:	08/31/2020

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Directions to “GREATER MINNESOTA FAMILY SERVICES ” Practice Location

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