Provider Demographics
NPI:1073136073
Name:NORTHLAND COUNSELING CENTER, INC.
Entity Type:Organization
Organization Name:NORTHLAND COUNSELING CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AR MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:FAYE
Authorized Official - Last Name:SCHELDRUP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-327-1151
Mailing Address - Street 1:215 SE 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55744-3615
Mailing Address - Country:US
Mailing Address - Phone:218-327-1151
Mailing Address - Fax:218-327-6085
Practice Address - Street 1:601 BUNKER HILL DR
Practice Address - Street 2:
Practice Address - City:AITKIN
Practice Address - State:MN
Practice Address - Zip Code:56431-1864
Practice Address - Country:US
Practice Address - Phone:218-670-0005
Practice Address - Fax:218-429-0017
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHLAND COUNSELING CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-05-26
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty