Provider Demographics
NPI:1104651355
Name:MINNESOTA STATE COLLEGES & UNIVERSITIES
Entity type:Organization
Organization Name:MINNESOTA STATE COLLEGES & UNIVERSITIES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CENTER DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DARCIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS-GAGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-389-1301
Mailing Address - Street 1:1600 WARREN ST STE 6
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-7113
Mailing Address - Country:US
Mailing Address - Phone:507-389-1443
Mailing Address - Fax:
Practice Address - Street 1:1600 WARREN ST STE 6
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-7113
Practice Address - Country:US
Practice Address - Phone:507-389-1443
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MINNESOTA STATE COLLEGES AND UNIVERSITIES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-09-06
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty