Organization
MANGATA COUNSELING SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DANIELLE MARIE FISCHER MARTI MSW, LICSW (OWNER)
(507) 276-7703
Entity
Organization
Contact information
Practice address
510 1ST ST N STE B, NEW ULM, MN 56073-1771
(507) 276-7703
Mailing address
49294 239TH AVE, LAKE CRYSTAL, MN 56055-2315
(507) 276-7703
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14122708
CAQH
MN
05
—
1790091452
—
MN
Enumeration date
01/18/2020
Last updated
03/10/2020
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