Healthcare Provider Details

I. General information

NPI: 1760088553
Provider Name (Legal Business Name): ROSSOW COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2020
Last Update Date: 03/28/2024
Certification Date: 03/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 E 9TH ST
DULUTH MN
55805-1604
US

IV. Provider business mailing address

4131 COLORADO ST
DULUTH MN
55804-1406
US

V. Phone/Fax

Practice location:
  • Phone: 218-428-4956
  • Fax:
Mailing address:
  • Phone: 218-428-4956
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DANIEL ROSSOW
Title or Position: LPCC
Credential: LPCC
Phone: 218-428-4956