Organization · Type 2 NPI

FDL Adolescent Outpatient TX

Adolescent and Children Mental Health Clinic/Center · Cloquet, MN

NPI number 1447606959 Active

Practice location

927 Trettel Ln
Cloquet, MN 55720-1345

Specialties and licenses

Taxonomy	Code	License
Adolescent and Children Mental Health Clinic/Center Primary	261QM0855X	None listed

Adolescent and Children Mental Health Clinic/Center: An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in children and adolescents. Services may be provided to parents and family members of the patient in the form of conjoint, group, or individual therapy, and education and/or training.

76 other providers at this address

NPI record

NPI: 1447606959
Entity type: Organization (Type 2)
Issued: May 13, 2016
Last updated: Oct 10, 2016
Status: Active
Subpart: Yes of Fond Du Lac Human Services Division

Other names

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Fond Du Lac Reservation Business Committee · former legal business name

Authorized official

Marilyn Grover
Associate Director
(218) 879-1227

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This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1447606959

FDL Adolescent Outpatient TX's National Provider Identifier is 1447606959, issued on May 13, 2016. The primary taxonomy on file is Adolescent and Children Mental Health Clinic/Center (261QM0855X), and the practice location is in Cloquet, MN. The record was last updated on Oct 10, 2016.