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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
Midwest Mental Health
Organization subpart
Yes
Provider details
NPI number
Legal business name
MIDWEST MENTAL HEALTH CLINIC PLLC
Authorized official
JACQUALINE KAY GERVAIS DNP, PMHNP, CARN-AP (PRESIDENT/OWNER)
(701) 371-9769
Entity
Organization
Contact information
Practice address
121 UNIVERSITY DR N, FARGO, ND 58102-4631
(701) 478-5808
Mailing address
1122 1ST AVE N, FARGO, ND 58102-4604
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
09/21/2022
Last updated
06/27/2024
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