Provider Demographics
NPI:1972626976
Name:SOUTHWESTERN MINNESOTA ADULT MENTAL HEALTH CONSORTIUM
Entity type:Organization
Organization Name:SOUTHWESTERN MINNESOTA ADULT MENTAL HEALTH CONSORTIUM
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BOARD CHAIR
Authorized Official - Prefix:MR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCALLISTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-372-2157
Mailing Address - Street 1:2200 23RD ST NE
Mailing Address - Street 2:SUITE 2050
Mailing Address - City:WILLMAR
Mailing Address - State:MN
Mailing Address - Zip Code:56201-6600
Mailing Address - Country:US
Mailing Address - Phone:320-441-6340
Mailing Address - Fax:320-441-6340
Practice Address - Street 1:215 MILKY WAY STREET SOUTH
Practice Address - Street 2:
Practice Address - City:COSMOS
Practice Address - State:MN
Practice Address - Zip Code:56228
Practice Address - Country:US
Practice Address - Phone:320-877-7220
Practice Address - Fax:320-877-7479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty