Provider Demographics
NPI:1043451370
Name:SACAJAWEA SUBSTANCE ABUSE COUNSELING AND DRUG TESTING CENTER
Entity Type:Organization
Organization Name:SACAJAWEA SUBSTANCE ABUSE COUNSELING AND DRUG TESTING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:KUHN
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:701-483-9150
Mailing Address - Street 1:112 3RD ST W
Mailing Address - Street 2:SUITE 301
Mailing Address - City:DICKINSON
Mailing Address - State:ND
Mailing Address - Zip Code:58601-5136
Mailing Address - Country:US
Mailing Address - Phone:701-483-9150
Mailing Address - Fax:
Practice Address - Street 1:112 3RD STREET WEST
Practice Address - Street 2:SUITE 301
Practice Address - City:DICKINSON
Practice Address - State:ND
Practice Address - Zip Code:58601
Practice Address - Country:US
Practice Address - Phone:701-483-9150
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-17
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1592261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)