Organization
PORT OF CROW WING COUNTY, INC
Active
Other names
DBA Lakes Area Counseling
Organization subpart
No
Provider details
NPI number
Authorized official
MS. AMY HAIDER (CREDENTIALING MANAGER)
(320) 639-1425
Entity
Organization
Contact information
Practice address
1906 5TH AVE SE, LITTLE FALLS, MN 56345-3317
(320) 632-6647
(320) 632-9525
Mailing address
PO BOX 367, LITTLE FALLS, MN 56345-0367
(320) 632-6647
(320) 639-0014
Taxonomy
Speciality
Code
Description
License number
State
103TB0200X
Cognitive & Behavioral Psychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006031300
—
MN
01
—
059T5PO
BLUECROSS BLUESHIELD
MN
01
—
131919
U CARE
MN
01
—
34B87PO
BLUECROSS BLUESHIELD
MN
01
—
62-764-39
UNITED BEHAVORIAL HEALTH
MN
01
—
82364
HEALTH PARTNERS
MN
Enumeration date
12/01/2006
Last updated
05/20/2022
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