Provider Demographics
NPI:1801968300
Name:LUTHERAN SOCIAL SERVICE OF MINNESOTA
Entity type:Organization
Organization Name:LUTHERAN SOCIAL SERVICE OF MINNESOTA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH PROFESSIONAL
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANNE
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:HALTERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, NCC
Authorized Official - Phone:320-235-5411
Mailing Address - Street 1:333 LITCHFIELD AVE SW
Mailing Address - Street 2:
Mailing Address - City:WILLMAR
Mailing Address - State:MN
Mailing Address - Zip Code:56201-3352
Mailing Address - Country:US
Mailing Address - Phone:320-235-5411
Mailing Address - Fax:320-235-2601
Practice Address - Street 1:333 LITCHFIELD AVENUE SW
Practice Address - Street 2:
Practice Address - City:WILLMAR
Practice Address - State:MN
Practice Address - Zip Code:56201-3352
Practice Address - Country:US
Practice Address - Phone:320-235-5411
Practice Address - Fax:320-235-2601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN00130101YM0800X
MNNCC 44742251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Not Answered251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN00130OtherL.P.C.
MN44742OtherNCC