Provider Demographics
NPI:1811169337
Name:WHITE EARTH TRIBAL MENTAL HEALTH
Entity type:Organization
Organization Name:WHITE EARTH TRIBAL MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ANYWAUSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-983-3285
Mailing Address - Street 1:35686 COUNTY HWY. 21
Mailing Address - Street 2:
Mailing Address - City:WHITE EARTH
Mailing Address - State:MN
Mailing Address - Zip Code:56591-0300
Mailing Address - Country:US
Mailing Address - Phone:218-983-3285
Mailing Address - Fax:218-983-4236
Practice Address - Street 1:35686 COUNTY HWY 21
Practice Address - Street 2:
Practice Address - City:WHITE EARTH
Practice Address - State:MN
Practice Address - Zip Code:56591-0300
Practice Address - Country:US
Practice Address - Phone:218-983-3285
Practice Address - Fax:218-983-4236
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WHITE EARTH TRIBAL HEALTH DEPARETMEN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-25
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND3181251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health