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NPI Code Detail

MEDICARE: WINONA COUNSELING CLINIC, INC.

MEDICARE: WINONA COUNSELING CLINIC, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251S00000XCommunity/Behavioral Health Agency8306881CDTMN
2251S00000XCommunity/Behavioral Health Agency2009WI
3251S00000XCommunity/Behavioral Health Agency1028139-1-MHCMN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
138266WIOTHERMNBLUE CROSS BLUE SHIELD
2128661OTHERMNUCARE
39166WIOTHERMNBLUE CROSS BLUE SHIELD CD
4326930OTHERMNVALUE OPTIONS

General Provider Information

NPI Number : 1841344116
Entity Type Code : Organization
Provider Name (Legal Business Name) : WINONA COUNSELING CLINIC, INC.
Provider Business Mailing Address
First Line : 111 RIVERFRONT
Second Line : SUITE 210
City : WINONA
State : MN
Zip : 55987-3456
Country : US
Telephone Number : 507-454-3900
Fax Number : 507-452-7459
Provider Business Practice Location Address
First Line : 111 RIVERFRONT
Second Line : SUITE 210
City : WINONA
State : MN
Zip : 55987-3456
Country : US
Telephone Number : 507-454-3900
Fax Number : 507-452-7459
Authorized Official
Title or Position : DIRECTOR / OWNER
Name : MS. MICHELLE L JOHNSON
Credential : MS, LPCC, LPC, LADC
Telephone Number : 507-454-3900
Provider Enumeration Date : 01/23/2007
Last Update Date : 04/11/2012

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