Provider Demographics
NPI:1225387327
Name:AVALON MERIDIAN BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:AVALON MERIDIAN BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DRUG AND ALCOHOL COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LEONE
Authorized Official - Middle Name:MAUREEN
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:BS , LADC
Authorized Official - Phone:320-629-1362
Mailing Address - Street 1:645 3RD AVENUE SW
Mailing Address - Street 2:
Mailing Address - City:PINE CITY
Mailing Address - State:MN
Mailing Address - Zip Code:55063
Mailing Address - Country:US
Mailing Address - Phone:320-629-1362
Mailing Address - Fax:320-629-3454
Practice Address - Street 1:645 3RD AVENUE SW
Practice Address - Street 2:
Practice Address - City:PINE CITY
Practice Address - State:MN
Practice Address - Zip Code:55063
Practice Address - Country:US
Practice Address - Phone:320-629-1362
Practice Address - Fax:320-629-3454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-05
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN303283302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization