Healthcare Provider Details

I. General information

NPI: 1043311368
Provider Name (Legal Business Name): NORTH SUBURBAN COUNSELING CTR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 COON RAPIDS BLVD #200
COON RAPIDS MN
55433
US

IV. Provider business mailing address

425 COON RAPIDS BLVD #200
COON RAPIDS MN
55433
US

V. Phone/Fax

Practice location:
  • Phone: 763-784-3008
  • Fax: 763-784-3647
Mailing address:
  • Phone: 763-784-3008
  • Fax: 763-784-3647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number801741MHC
License Number StateMN

VIII. Authorized Official

Name: MS. GRETCHEN M WESCHESHERMAY
Title or Position: EXECUTIVE DIRECTOR
Credential: LICSW
Phone: 763-784-3008