Bad River Band of Lake Superior Tribe of Chippewa Indains Wis

NPI #1366618506 in Ashland, Wisconsin

Provider Information

NPI Number: 1366618506
Entity Type: Organization
Organization Name: Bad River Band of Lake Superior Tribe of Chippewa Indains Wis
Subpart: Yes (part of a larger organization)
Parent Organization: BAD RIVER BAND OF LAKE SUPERIOR TRIBE OF CHIPPEWA INDIANS WIS
Primary Specialty: Clinic/Center - Mental Health (Including Community Mental Health Center)
Enumeration Date: May 7, 2008
Last Updated: Feb 8, 2017

Practice Location

Address: 53585 NOKOMIS RD
City: Ashland
State: Wisconsin
ZIP Code: 54806-4272
Phone: (715) 682-7133

Authorized Official

Name: MRS. DEBRA A TUTOR
Title: CLINIC ADMINISTRATOR
Phone: (715) 682-7133

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Clinic/Center - Mental Health (Including Community Mental Health Center) — Mental Health (Including Community Mental Health Center)	261QM0801X	Primary

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