Provider Demographics
NPI:1417258237
Name:ST LOUIS COUNTY PHHS DEPT
Entity Type:Organization
Organization Name:ST LOUIS COUNTY PHHS DEPT
Other - Org Name:SLC BEHAVIORAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ACCOUNTING SUPERVISOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:H
Authorized Official - Last Name:MOELLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-726-2057
Mailing Address - Street 1:320 W 2ND ST
Mailing Address - Street 2:ROOM 409
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55802-1404
Mailing Address - Country:US
Mailing Address - Phone:218-726-2057
Mailing Address - Fax:218-733-2970
Practice Address - Street 1:320 W 2ND ST
Practice Address - Street 2:ROOM 409
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802-1404
Practice Address - Country:US
Practice Address - Phone:218-726-2057
Practice Address - Fax:218-733-2970
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST LOUIS COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-11-10
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health