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Organization
MIDWEST MENTAL HEALTH CLINIC PLLC
Active
Organization
MIDWEST MENTAL HEALTH CLINIC PLLC
Active
Parent organization
MIDWEST MENTAL HEALTH CLINIC PLLC
Other names
Grey Matters Mental Health Clinic
Organization subpart
Yes
Provider details
NPI number
Legal business name
MIDWEST MENTAL HEALTH CLINIC PLLC
Authorized official
JACQUALINE KAY GERVAIS (OWNER)
(701) 371-9769
Entity
Organization
Contact information
Practice address
5306 BALLARD AVE NW STE 208, SEATTLE, WA 98107-4366
(206) 607-9205
Mailing address
819 30TH AVE S STE 206, MOORHEAD, MN 56560-5054
(218) 477-1353
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
NULL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
01/09/2023
Last updated
01/09/2023
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