Healthcare Provider Details

I. General information

NPI: 1407044886
Provider Name (Legal Business Name): DBA MARK PERKINS COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2007
Last Update Date: 01/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 1ST AVE NE SUITE 111-D
ROCHESTER MN
55906-4170
US

IV. Provider business mailing address

2247 68TH ST NW
ROCHESTER MN
55901-8862
US

V. Phone/Fax

Practice location:
  • Phone: 507-529-1758
  • Fax: 507-289-1536
Mailing address:
  • Phone: 507-529-1758
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number10475091CDT
License Number StateMN

VIII. Authorized Official

Name: MR. MARK GREGORY PERKINS
Title or Position: DIRECTOR
Credential: LADC
Phone: 507-529-1758