Organization
CENTRAL MINNESOTA MENTAL HEALTH CENTER
Active
Other names
Focus XII
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID BARAGA PH.D, LP (EXECUTIVE DIRECTOR)
(320) 202-2033
Entity
Organization
Contact information
Practice address
3220 8TH STREET NORTH, SAINT CLOUD, MN 56303-3128
(320) 252-2425
(320) 529-1976
Mailing address
1321 13TH ST N, SAINT CLOUD, MN 56303-2613
(320) 252-5010
(320) 203-1855
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
800832-2-CDT
MN
324500000X
Substance Abuse Rehabilitation Facility
Primary
800832-2-CDT
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
676555600
PROVIDER NUMBER
MN
Enumeration date
04/06/2007
Last updated
12/20/2010
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