Basic Information
| Provider Information | |||||||||
| NPI: | 1225372832 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RISING UP, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3315 ROOSEVELT RD STE 200A | ||||||||
| Address2: | |||||||||
| City: | SAINT CLOUD | ||||||||
| State: | MN | ||||||||
| PostalCode: | 563016269 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3202294069 | ||||||||
| FaxNumber: | 3202294071 | ||||||||
| Practice Location | |||||||||
| Address1: | 3315 ROOSEVELT RD STE 200A | ||||||||
| Address2: | |||||||||
| City: | SAINT CLOUD | ||||||||
| State: | MN | ||||||||
| PostalCode: | 563016269 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3202294069 | ||||||||
| FaxNumber: | 3202294071 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/20/2012 | ||||||||
| LastUpdateDate: | 11/20/2012 | ||||||||
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| AuthorizedOfficialLastName: | HAPPE | ||||||||
| AuthorizedOfficialFirstName: | CINDY | ||||||||
| AuthorizedOfficialMiddleName: | A.T. | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/THERAPIST | ||||||||
| AuthorizedOfficialTelephone: | 3202678704 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LICSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | 15109 | MN | Y | Agencies | Community/Behavioral Health |
No ID Information.