Organization
LEECH LAKE BAND OF OJIBWE
Active
Other names
Leech Lake Adolescent Outpatient Services
Organization subpart
No
Provider details
NPI number
Authorized official
EARL ROBINSON (HUMAN SERVICES DIRECTOR)
(218) 335-8295
Entity
Organization
Contact information
Practice address
321 2ND ST, CASS LAKE, MN 56633
(218) 335-8382
(218) 335-3580
Mailing address
190 SAILSTAR DR NW, CASS LAKE, MN 56633
(218) 335-8382
(218) 335-3580
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
—
—
Other
Enumeration date
06/19/2014
Last updated
01/31/2019
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