Healthcare Provider Details

I. General information

NPI: 1619961711
Provider Name (Legal Business Name): NORTH SUBURBAN COUNSELING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 COON RAPIDS BLVD NW
COON RAPIDS MN
55433-2753
US

IV. Provider business mailing address

425 COON RAPIDS BLVD. NW
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 Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number801741-1 MHC
License Number StateMN

VIII. Authorized Official

Name: GRETCHEN WESCHE SHERMAN
Title or Position: EXECUTIVE DIRECTOR
Credential: LICSW
Phone: 763-784-3008