Provider Demographics
| NPI: | 1659134005 |
|---|---|
| Name: | MINNIETALKS2YOU |
| Entity type: | Organization |
| Organization Name: | MINNIETALKS2YOU |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | COMMUNICATION TRUSTEE OFFICER |
| Authorized Official - Prefix: | MRS |
| Authorized Official - First Name: | MINNETTE |
| Authorized Official - Middle Name: | KATHLEEN |
| Authorized Official - Last Name: | GAMBLE |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | PHD, LMSW |
| Authorized Official - Phone: | 616-799-4419 |
| Mailing Address - Street 1: | 166 MAPLE ST |
| Mailing Address - Street 2: | |
| Mailing Address - City: | SPARTA |
| Mailing Address - State: | MI |
| Mailing Address - Zip Code: | 49345-1310 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 616-799-4419 |
| Mailing Address - Fax: | 616-205-5017 |
| Practice Address - Street 1: | 168 MAPLE ST |
| Practice Address - Street 2: | |
| Practice Address - City: | SPARTA |
| Practice Address - State: | MI |
| Practice Address - Zip Code: | 49345-1310 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 616-799-4419 |
| Practice Address - Fax: | 616-205-5017 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2024-01-30 |
| Last Update Date: | 2024-01-30 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Multi-Specialty |
| No | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
| No | 103TP2701X | Behavioral Health & Social Service Providers | Psychologist | Group Psychotherapy | Group - Multi-Specialty |
| No | 104100000X | Behavioral Health & Social Service Providers | Social Worker | Group - Multi-Specialty | |
| No | 1041S0200X | Behavioral Health & Social Service Providers | Social Worker | School | Group - Multi-Specialty |
| No | 251B00000X | Agencies | Case Management | Group - Multi-Specialty | |
| No | 251C00000X | Agencies | Day Training, Developmentally Disabled Services | ||
| No | 251E00000X | Agencies | Home Health | ||
| No | 251S00000X | Agencies | Community/Behavioral Health | ||
| No | 261QD1600X | Ambulatory Health Care Facilities | Clinic/Center | Developmental Disabilities | |
| No | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | |
| No | 385HR2060X | Respite Care Facility | Respite Care | Respite Care, Intellectual and/or Developmental Disabilities, Child | |
| No | 385HR2065X | Respite Care Facility | Respite Care | Respite Care, Physical Disabilities, Child |
