MILLE LACS ACADEMY (NPI# 1063773174) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1063773174 |
| Entity Type | Organization |
| Organization Name | MILLE LACS ACADEMY |
| Practice Address |
407 130th Ave S Onamia MN 56359-3115 |
| Practice Telephone | 3205324005 |
| Enumeration Date | 2012-06-05 |
| Last Update Date | 2012-06-05 |
| Authorized Official Name | JAN GIBSON TALBOT (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 3205324005 |
| Authorized Official Credential | LICSW |
| Is Organization Subpart | Y |
| Parent Organization Name | NEXUS |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TP0016X |
Psychologist Specialization: Prescribing (Medical) |
1036935-2-CRF | MN | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | NPI FOR RESIDENTIAL TREATMENT FACILITY | 1700958881 | 01 |
| Street Address |
407 130TH AVE S |
| City | ONAMIA |
| State | MN |
| Zip Code | 56359-3115 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780777615 | Diana Ochoa Chu | Psychiatry & Neurology | 407 130th Ave S, Onamia, MN 56359 | 2006-10-02 |
| 1457802852 | Nexus | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 407 130th Ave S, Onamia, MN 56359-3115 | 2016-10-20 |
| 1588088405 | Jeffrey Breer | Social Worker | 407 130th Ave S, Onamia, MN 56359-3115 | 2014-02-12 |
| 1780008128 | Jan Gibson Talbot | Social Worker | 407 130th Ave S, Onamia, MN 56359-3115 | 2014-02-05 |
| 1649534165 | Katherine S Glassford | Counselor | 407 130th Ave S, Onamia, MN 56359-3115 | 2012-06-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588185417 | Stephanie Lynn Conzet | Registered Nurse | 200 North Elm Street North, Mille Lacs Family Clinic, Onamia, MN 56359 | 2017-06-30 |
| 1760759880 | Joseph Nayquonabe | Counselor | 42273 Twilight Road, Onamia, MN 56359 | 2011-11-17 |
| 1548496060 | Mille Lacs Band of Ojibwe Indians | Substance Abuse Rehabilitation Facility | 17222 Ataage Dr, Onamia, MN 56359 | 2009-06-10 |
| 1831388909 | Mille Lacs Band of Ojibwe Indians | Community/Behavioral Health | 42293 Twilight Rd, Onamia, MN 56359 | 2007-10-15 |
| 1982729364 | Mille Lacs Band of Ojibwe Indians | Pharmacy | 43500 Migizi Drive, Onamia, MN 56359 | 2007-03-21 |
| 1639205370 | Jennifer Lee Hewitt | Registered Nurse | 17230 Noopiming Drive, Onamia, MN 56359 | 2007-02-26 |
| 1164569760 | Betty Nichols | Registered Nurse | 17230 Noopiming Dr., Onaima, MN 56359 | 2007-01-31 |
| 1639224975 | Deanna M Duret | Dietitian, Registered | 200 Elm Street North, Onamia, MN 56359 | 2007-01-25 |
| 1700958881 | Nexus | Community Based Residential Treatment Facility, Mental Illness | 407 130th Avenue South, Onamia, MN 56359 | 2006-11-14 |
| 1699390518 | Mille Lacs Band of Ojibwe Indians | Community/Behavioral Health | 18562 Minobimaadizi Loop, Onamia, MN 56359 | 2020-06-16 |
| Find all providers in zip 56359 | ||||
| Taxonomy Code | 103TP0016X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Prescribing (Medical) |
| Those licensed psychologists who have completed specialized, post-doctoral training in psychopharmacology, passed a national proficiency examination in psychopharmacology, and who are authorized by state statute to prescribe medications, in accordance with their state law and state licensing authority, for the evaluation, diagnosis, management and treatment of mental, nervous, emotional, behavioral, and related disorders. |
| Notes: Source: Louisiana Academy of Medical Psychologists Note: Some states issue licenses under Medical Psychologist. [1/1/2007: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740683515 | Tamber Health of Minnesota, P.C. | Psychologist | 2657 Woodbridge Rd, Wayzata, MN 55391-9406 | 2014-10-07 |
| 1457563942 | Helen Kim, Md, PC | Psychologist | 3133 Hennepin Avenue, Minneapolis, MN 55408 | 2007-05-04 |
| 1851785216 | Corolla Health Plc | Psychologist | 3920 13th Ave E, Suite 6, Hibbing, MN 55746-3675 | 2015-03-24 |
| 1457564510 | Janet Woehrle | Psychologist | 215 Se 2nd Ave, Grand Rapids, MN 55744-3615 | 2007-05-07 |
| 1003037524 | Dianne Lynn Lockman | Psychologist | 3919 W 44th St Ste 200, Edina, MN 55424-1032 | 2007-05-01 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.