Organization
LEECH LAKE OUTPATIENT TREATMENT PROGRAM
Active
Parent organization
LEECH LAKE BAND OF OJIBWE
Organization subpart
Yes
Provider details
NPI number
Legal business name
LEECH LAKE BAND OF OJIBWE
Authorized official
MS. GLORIA MELLADO (A & D PROGRAM DIRECTOR)
(218) 335-3567
Entity
Organization
Contact information
Practice address
6095 161ST AVE NW, CASS LAKE, MN 56633-3428
(218) 335-8308
(218) 335-8307
Mailing address
6905 161ST ST. NW, CASS LAKE, MN 56633-3428
(218) 335-8308
(218) 335-8307
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
02/19/2008
Last updated
07/18/2008
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