Provider Demographics
NPI:1568693091
Name:STEVENS COUNTY HUMAN SERVICES
Entity Type:Organization
Organization Name:STEVENS COUNTY HUMAN SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH PROFESSIONAL/HUMAN SE
Authorized Official - Prefix:MRS
Authorized Official - First Name:LIBERTY
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:SLEITER
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:320-208-6600
Mailing Address - Street 1:400 COLORADO AVENUE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MORRIS
Mailing Address - State:MN
Mailing Address - Zip Code:56267
Mailing Address - Country:US
Mailing Address - Phone:320-208-6600
Mailing Address - Fax:320-589-3972
Practice Address - Street 1:10 E HIGHWAY 28
Practice Address - Street 2:
Practice Address - City:MORRIS
Practice Address - State:MN
Practice Address - Zip Code:56267-1176
Practice Address - Country:US
Practice Address - Phone:320-589-7400
Practice Address - Fax:320-589-3972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-31
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNA000075200251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNA000075200Medicaid