Organization
MERITCARE 1219
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA M CARLSON (CFO)
701233344811
Entity
Organization
Contact information
Practice address
1219 S WASHINGTON AVE, DETROIT LAKES, MN 56501-3905
(218) 846-2000
Mailing address
1219 S WASHINGTON AVE, DETROIT LAKES, MN 56501-3905
(218) 846-2000
Taxonomy
Speciality
Code
Description
License number
State
103TF0000X
Family Psychologist
Primary
—
—
Other
Enumeration date
08/07/2008
Last updated
08/13/2008
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