Provider Demographics
NPI:1689374613
Name:THE WAY MENTAL HEALTH SERVICES PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:THE WAY MENTAL HEALTH SERVICES PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRPERSON OF THE BOARD
Authorized Official - Prefix:MRS
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:GIBBS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-382-6916
Mailing Address - Street 1:PO BOX 127
Mailing Address - Street 2:
Mailing Address - City:CROSSLAKE
Mailing Address - State:MN
Mailing Address - Zip Code:56442-0127
Mailing Address - Country:US
Mailing Address - Phone:612-220-7257
Mailing Address - Fax:
Practice Address - Street 1:35548 COUNTY ROAD 66
Practice Address - Street 2:
Practice Address - City:CROSSLAKE
Practice Address - State:MN
Practice Address - Zip Code:56442-4115
Practice Address - Country:US
Practice Address - Phone:218-692-5152
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-08
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty