Provider Demographics
NPI:1902675747
Name:GREATER MIDWEST COUNSELING SERVICE
Entity Type:Organization
Organization Name:GREATER MIDWEST COUNSELING SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREATMENT DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GATLUAK
Authorized Official - Middle Name:
Authorized Official - Last Name:TUTDEAL
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:507-213-0002
Mailing Address - Street 1:12 CIVIC CENTER PLZ STE 3000B
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-7713
Mailing Address - Country:US
Mailing Address - Phone:507-213-0002
Mailing Address - Fax:
Practice Address - Street 1:12 CIVIC CENTER PLZ STE 3000B
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-7713
Practice Address - Country:US
Practice Address - Phone:507-213-0002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-21
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health