Provider Demographics
NPI:1053576546
Name:CENTRAL MINNESOTA MENTAL HEALTH CENTER
Entity type:Organization
Organization Name:CENTRAL MINNESOTA MENTAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:BARAGA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD LP
Authorized Official - Phone:320-252-5010
Mailing Address - Street 1:3333 W DIVISION ST
Mailing Address - Street 2:SUITE 219
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56301-4515
Mailing Address - Country:US
Mailing Address - Phone:320-257-4230
Mailing Address - Fax:320-257-2201
Practice Address - Street 1:3333 W DIVISION ST
Practice Address - Street 2:SUITE 219
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56301-4515
Practice Address - Country:US
Practice Address - Phone:320-257-4230
Practice Address - Fax:320-257-2201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-23
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty