# MIDWEST MENTAL HEALTH CLINIC PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1861877052
- **Authorized official:** JACQUALINE GERVAIS PMHNP (OWNER)
- **Authorized official phone:** (218) 477-1353

## Contact information

- **Practice address:** 1122 1ST AVE N, FARGO, ND 58102-4604
- **Practice address phone:** (218) 477-1353
- **Practice address fax:** (218) 477-1354
- **Mailing address:** 819 30TH AVE S OFFICE 206 SUITE B, MOORHEAD, MN 56560
- **Mailing address phone:** (218) 477-1353
- **Mailing address fax:** (218) 477-1354

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | CNP3899 | MN | Yes |

## Other

- **Enumeration date:** 07/29/2015
- **Last updated:** 01/17/2023