Organization
IRON RANGE BEHAVIORAL SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARK F WICKER (PRESIDENT)
(218) 341-8523
Entity
Organization
Contact information
Practice address
910 8TH ST S STE B, VIRGINIA, MN 55792-3236
(218) 748-8500
(218) 748-8501
Mailing address
PO BOX 236, COTTON, MN 55724-0236
(218) 341-8523
(218) 212-3444
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
1041C0700X
Clinical Social Worker
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
261Q00000X
Clinic/Center
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Enumeration date
07/29/2020
Last updated
06/04/2024
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