Healthcare Provider Details

I. General information

NPI: 1295265783
Provider Name (Legal Business Name): INSIGHT COUNSELING DULUTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2017
Last Update Date: 09/30/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 W SUPERIOR ST STE 1000
DULUTH MN
55802-1818
US

IV. Provider business mailing address

5223 PINE SHORE DR
DULUTH MN
55803
US

V. Phone/Fax

Practice location:
  • Phone: 218-428-0048
  • Fax:
Mailing address:
  • Phone: 218-481-7660
  • Fax: 218-216-1452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number11195
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MIKE CLABAUGH
Title or Position: CFO
Credential: LGSW
Phone: 218-481-7660