PORT OF CROW WING COUNTY INC NPI 1205904612

NPI Information

  • NPI: 1205904612
  • Provider Name: PORT OF CROW WING COUNTY, INC
  • Classification: Psychologist - 103TB0200X
  • Specialization: Cognitive & Behavioral
  • Entity Type: Organization
  • Doing Business As: DBA LAKES AREA COUNSELING
  • Address: 1906 5TH AVE SE
    LITTLE FALLS, MN
    ZIP 56345
  • Phone: (320) 632-6647

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NPI Details

PORT OF CROW WING COUNTY, INC is a cognitive and behavioral psychologist in Little Falls, MN. The provider is a psychologist who reflects an experimental-clinical approach distinguished by use of principles of human learning and development and theories of cognitive processing to promote meaningful change in maladaptive human behavior and thinking. PORT OF CROW WING COUNTY, INC NPI is 1205904612. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Dba Lakes Area Counseling.

The provider's business location address is:

1906 5TH AVE SE
LITTLE FALLS, MN
ZIP 56345-317
Phone: (320) 632-6647
Fax: (320) 632-9525

The provider's authorized official is Amy Haider .
The authorized official title is Credentialing Manager and has the following contact phone number (320) 639-1425.

The enumeration date for this NPI number is 12/1/2006 and was last updated on 5/20/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1103TB0200XPsychologistCognitive & BehavioralYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1131919OTHERMINNESOTAU CARE
234B87POOTHERMINNESOTABLUECROSS BLUESHIELD
3006031300MEDICAIDMINNESOTA
482364OTHERMINNESOTAHEALTH PARTNERS
562-764-39OTHERMINNESOTAUNITED BEHAVORIAL HEALTH
6059T5POOTHERMINNESOTABLUECROSS BLUESHIELD

What is NPI?

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This page was last updated on: 3/30/2025

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