Provider Demographics
NPI:1033597216
Name:WHITE EARTH BAND OF CHIPPEWA INDIANS
Entity Type:Organization
Organization Name:WHITE EARTH BAND OF CHIPPEWA INDIANS
Other - Org Name:WHITE EARTH EDUCATION DIVISION CHILDREN'S SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:EDUCATION DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LAVOY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-983-3285
Mailing Address - Street 1:PO BOX 418
Mailing Address - Street 2:
Mailing Address - City:WHITE EARTH
Mailing Address - State:MN
Mailing Address - Zip Code:56591-0418
Mailing Address - Country:US
Mailing Address - Phone:218-983-3285
Mailing Address - Fax:218-983-3705
Practice Address - Street 1:35233 MISSION LAKE ROAD
Practice Address - Street 2:
Practice Address - City:WHITE EARTH
Practice Address - State:MN
Practice Address - Zip Code:56591
Practice Address - Country:US
Practice Address - Phone:218-983-4180
Practice Address - Fax:218-983-3767
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WHITE EARTH BAND OF CHIPPEWA INDIANS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-05-08
Last Update Date:2015-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN0504101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty