| Midwest Mental Health Clinic Pllc | |
|
1425 4th Ave N Fargo ND 58102-4233 | |
| (701) 478-5808 | |
| Not Available |
| Full Name | Midwest Mental Health Clinic Pllc |
|---|---|
| Speciality | Counselor - Addiction (substance Use Disorder) |
| Location | 1425 4th Ave N, Fargo, North Dakota |
| Authorized Official Name and Position | Jacqualine Kay Gervais (PRESIDENT/OWNER) |
| Authorized Official Contact | 7013719769 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Midwest Mental Health Clinic Pllc 1122 1st Ave N Fargo ND 58102-4604 Ph: () - | Midwest Mental Health Clinic Pllc 1425 4th Ave N Fargo ND 58102-4233 Ph: (701) 478-5808 |
| NPI Number | 1710600028 |
|---|---|
| Provider Enumeration Date | 09/21/2022 |
| Last Update Date | 09/21/2022 |
| Certification Date | 09/21/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710600028 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Primary |
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