Organization
BINESIIKWEG, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MELISSA GEORGE-HUMPHREY LICSW (PRESIDENT)
(218) 760-2222
Entity
Organization
Contact information
Practice address
522 BELTRAMI AVE NW, SUITE 115, BEMIDJI, MN 56601-3001
(218) 760-2222
Mailing address
522 BELTRAMI AVE NW, SUITE 115, BEMIDJI, MN 56601-3001
(218) 760-2222
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
288620100
—
MN
Enumeration date
07/15/2014
Last updated
07/15/2014
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