Provider Demographics
NPI:1962851253
Name:SOUTHWESTERN MENTAL HEALTH CENTER
Entity Type:Organization
Organization Name:SOUTHWESTERN MENTAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE SERVICES DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:VINZANT
Authorized Official - Suffix:
Authorized Official - Credentials:SHRM-SCP, SPHR, MSHR
Authorized Official - Phone:507-283-9511
Mailing Address - Street 1:117 S SPRING ST
Mailing Address - Street 2:
Mailing Address - City:LUVERNE
Mailing Address - State:MN
Mailing Address - Zip Code:56156-1916
Mailing Address - Country:US
Mailing Address - Phone:507-283-9511
Mailing Address - Fax:507-283-9514
Practice Address - Street 1:117 S SPRING ST
Practice Address - Street 2:
Practice Address - City:LUVERNE
Practice Address - State:MN
Practice Address - Zip Code:56156-1916
Practice Address - Country:US
Practice Address - Phone:507-283-9511
Practice Address - Fax:507-283-9514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-07
Last Update Date:2017-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN21451261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)