Provider Demographics
NPI:1134261290
Name:NORTHERN PINES MENTAL HEALTH CENTER, INC
Entity type:Organization
Organization Name:NORTHERN PINES MENTAL HEALTH CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:BUBLITZ
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:218-829-3235
Mailing Address - Street 1:407 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:BRAINERD
Mailing Address - State:MN
Mailing Address - Zip Code:56401-3034
Mailing Address - Country:US
Mailing Address - Phone:218-829-3235
Mailing Address - Fax:218-829-1368
Practice Address - Street 1:520 NW 5TH ST
Practice Address - Street 2:
Practice Address - City:BRAINERD
Practice Address - State:MN
Practice Address - Zip Code:56401-2902
Practice Address - Country:US
Practice Address - Phone:218-829-3235
Practice Address - Fax:218-829-1368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN05401251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health