Organization
CENTRAL MINNESOTA MENTAL HEALTH CENTER
Active
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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