Provider Demographics
NPI:1609869726
Name:GREATER MINNESOTA FAMILY SERVICES
Entity Type:Organization
Organization Name:GREATER MINNESOTA FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:DUBIE
Authorized Official - Suffix:
Authorized Official - Credentials:MS/LP
Authorized Official - Phone:320-214-9692
Mailing Address - Street 1:2320 HIGHWAY 12 E STE 2
Mailing Address - Street 2:
Mailing Address - City:WILLMAR
Mailing Address - State:MN
Mailing Address - Zip Code:56201-5811
Mailing Address - Country:US
Mailing Address - Phone:320-214-9692
Mailing Address - Fax:320-214-9924
Practice Address - Street 1:2320 HIGHWAY 12 E STE 2
Practice Address - Street 2:
Practice Address - City:WILLMAR
Practice Address - State:MN
Practice Address - Zip Code:56201-5811
Practice Address - Country:US
Practice Address - Phone:320-214-9692
Practice Address - Fax:320-214-9924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-24
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN810871-2-MHC101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN030726018OtherPRIMEWEST
MN60144OtherHEALTHPARTNERS
MN915319500Medicaid
MN05Q36GROtherBLUE CROSS BLUE SHIELD
MN005392900Medicaid
MN241016800Medicaid
MN62-54676OtherMEDICA/UBH
MN122230OtherBHP/UCARE