Provider Demographics
NPI:1194015727
Name:VINNES, HAROLD (EDD)
Entity Type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:
Last Name:VINNES
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4667 SECTION LINE RD
Mailing Address - Street 2:
Mailing Address - City:MOOSE LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55767-9410
Mailing Address - Country:US
Mailing Address - Phone:218-485-8720
Mailing Address - Fax:
Practice Address - Street 1:4667 SECTION LINE RD
Practice Address - Street 2:
Practice Address - City:MOOSE LAKE
Practice Address - State:MN
Practice Address - Zip Code:55767-9410
Practice Address - Country:US
Practice Address - Phone:218-485-8720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-16
Last Update Date:2011-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP2173103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical