Basic Information
| Provider Information | |||||||||
| NPI: | 1538643424 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROHRBAUCK | ||||||||
| FirstName: | MARCUS | ||||||||
| MiddleName: | JAMES | ||||||||
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| Credential: | LPCC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6120 EARLE BROWN DR STE 100 | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN CENTER | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554304100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7632771020 | ||||||||
| FaxNumber: | 7635377162 | ||||||||
| Practice Location | |||||||||
| Address1: | 1312-1314 LIVINGSTON AVENUE | ||||||||
| Address2: | |||||||||
| City: | WEST ST. PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55118 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6514576999 | ||||||||
| FaxNumber: | 6514512166 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/18/2018 | ||||||||
| LastUpdateDate: | 09/18/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | CC01894 | MN | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.