# MIDWEST MENTAL HEALTH CLINIC PLLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** MIDWEST MENTAL HEALTH CLINIC PLLC
- **Other names:** Grey Matters Mental Health Clinic
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1184338824
- **Legal business name:** MIDWEST MENTAL HEALTH CLINIC PLLC
- **Authorized official:** JACQUALINE KAY GERVAIS (OWNER)
- **Authorized official phone:** (701) 371-9769

## Contact information

- **Practice address:** 5306 BALLARD AVE NW STE 208, SEATTLE, WA 98107-4366
- **Practice address phone:** (206) 607-9205
- **Mailing address:** 819 30TH AVE S STE 206, MOORHEAD, MN 56560-5054
- **Mailing address phone:** (218) 477-1353

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 01/09/2023
- **Last updated:** 01/09/2023