Provider Demographics
NPI:1053627984
Name:NORTHERN STATE UNIVERSITY
Entity Type:Organization
Organization Name:NORTHERN STATE UNIVERSITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:V.P OF FINANCE & ADMINISTRATION
Authorized Official - Prefix:MR
Authorized Official - First Name:DON
Authorized Official - Middle Name:
Authorized Official - Last Name:ERLENBUSCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-626-2566
Mailing Address - Street 1:1200 S JAY ST
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:SD
Mailing Address - Zip Code:57401-7155
Mailing Address - Country:US
Mailing Address - Phone:605-626-2566
Mailing Address - Fax:
Practice Address - Street 1:1200 S JAY ST
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401-7155
Practice Address - Country:US
Practice Address - Phone:605-626-2566
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-30
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty