Provider Demographics
NPI:1578162012
Name:BEMIDJI AUTISM AND CHILDREN'S THERAPY LLC
Entity Type:Organization
Organization Name:BEMIDJI AUTISM AND CHILDREN'S THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:HUYGE-OPSAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-760-3323
Mailing Address - Street 1:522 BELTRAMI AVE NW STE 110
Mailing Address - Street 2:
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56601-3002
Mailing Address - Country:US
Mailing Address - Phone:218-760-3323
Mailing Address - Fax:218-333-3534
Practice Address - Street 1:522 BELTRAMI AVE NW STE 110
Practice Address - Street 2:
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-3002
Practice Address - Country:US
Practice Address - Phone:218-255-2749
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-24
Last Update Date:2022-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty