Healthcare Provider Details

I. General information

NPI: 1679717524
Provider Name (Legal Business Name): MENTAL HEALTH COUNSELING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2009
Last Update Date: 07/01/2024
Certification Date: 07/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 1ST AVE NE SUITE 310
MINNEAPOLIS MN
55413-2419
US

IV. Provider business mailing address

615 1ST AVE NE SUITE 310
MINNEAPOLIS MN
55413-2419
US

V. Phone/Fax

Practice location:
  • Phone: 612-436-0295
  • Fax: 612-436-0163
Mailing address:
  • Phone: 612-436-0295
  • Fax: 612-436-0163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: VICKI DEAN-GRAMLICH
Title or Position: PRESIDENT
Credential: APRN, PMHCNS-BC
Phone: 612-436-0295