Provider Demographics
NPI:1366480287
Name:LAKELAND MENTAL HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:LAKELAND MENTAL HEALTH CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-299-6669
Mailing Address - Street 1:980 S TOWER RD
Mailing Address - Street 2:
Mailing Address - City:FERGUS FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56537-5505
Mailing Address - Country:US
Mailing Address - Phone:218-736-6987
Mailing Address - Fax:218-736-0734
Practice Address - Street 1:980 S TOWER RD
Practice Address - Street 2:
Practice Address - City:FERGUS FALLS
Practice Address - State:MN
Practice Address - Zip Code:56537-5505
Practice Address - Country:US
Practice Address - Phone:218-736-6987
Practice Address - Fax:218-736-0734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN434755200251B00000X
MN434755211251B00000X
MN434755212251B00000X
MN801338-1-MHC261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN434755212Medicaid
MN030701035OtherPRIME WEST HEALTH SYSTEM
MN250357300Medicaid
MN434755211Medicaid
MN109513OtherUCARE MINNESOTA
MN434755200Medicaid
MN62522LAOtherBLUE SHIELD OF MINNESOTA
MN434755211Medicaid
MN434755212Medicaid
MN434755213Medicare ID - Type UnspecifiedCASE MANAGEMENT BECKER CO
MN250357300Medicaid