Provider Demographics
NPI:1306042098
Name:MOUNTAIN-PLAINS YOUTH SERVICES COALITION
Entity Type:Organization
Organization Name:MOUNTAIN-PLAINS YOUTH SERVICES COALITION
Other - Org Name:YOUTHWORKS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:HEITKAMP
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:701-255-6909
Mailing Address - Street 1:217 W ROSSER AVE
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-3755
Mailing Address - Country:US
Mailing Address - Phone:701-255-6909
Mailing Address - Fax:701-255-3922
Practice Address - Street 1:217 W ROSSER AVE
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-3755
Practice Address - Country:US
Practice Address - Phone:701-255-6909
Practice Address - Fax:701-255-3922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-21
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
6192001OtherGROUP BCBS OF ND