Organization
MINO-MIIKANAANG BIMA'ADOO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TASHINA LERAE BRANCHAUD LSW, LADC, CADCII (OWNER)
(218) 368-2472
Entity
Organization
Contact information
Practice address
14468 LITTLE ROCK ST., RED LAKE, MN 56671
(218) 368-2472
Mailing address
PO BOX 1105, REDLAKE, MN 56671-1105
(218) 368-2472
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
05/03/2022
Last updated
05/03/2022
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