Basic Information
| Provider Information | |||||||||
| NPI: | 1043311368 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTH SUBURBAN COUNSELING CTR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 425 COON RAPIDS BLVD | ||||||||
| Address2: | #200 | ||||||||
| City: | COON RAPIDS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55433 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7637843008 | ||||||||
| FaxNumber: | 7637843647 | ||||||||
| Practice Location | |||||||||
| Address1: | 425 COON RAPIDS BLVD | ||||||||
| Address2: | #200 | ||||||||
| City: | COON RAPIDS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55433 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7637843008 | ||||||||
| FaxNumber: | 7637843647 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/26/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | WESCHESHERMAY | ||||||||
| AuthorizedOfficialFirstName: | GRETCHEN | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7637843008 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | LICSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251B00000X | 801741MHC | MN | Y | Agencies | Case Management |
No ID Information.