Provider Demographics
NPI:1972950962
Name:LAKELAND MENTAL HEALTH CENTER
Entity Type:Organization
Organization Name:LAKELAND MENTAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CLAIR
Authorized Official - Middle Name:
Authorized Official - Last Name:PRODY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-739-1729
Mailing Address - Street 1:980 S TOWER RD
Mailing Address - Street 2:
Mailing Address - City:FERGUS FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56537-5505
Mailing Address - Country:US
Mailing Address - Phone:218-736-6987
Mailing Address - Fax:218-736-0734
Practice Address - Street 1:980 S TOWER RD
Practice Address - Street 2:
Practice Address - City:FERGUS FALLS
Practice Address - State:MN
Practice Address - Zip Code:56537-5505
Practice Address - Country:US
Practice Address - Phone:218-736-6987
Practice Address - Fax:218-736-0734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-19
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN801338-1171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty