Healthcare Provider Details

I. General information

NPI: 1588731327
Provider Name (Legal Business Name): CENTER FOR FAMILY COUNSELING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 04/08/2024
Certification Date: 04/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2025 STEARNS WAY SUITE 111
ST CLOUD MN
56303
US

IV. Provider business mailing address

2025 STEARNS WAY SUITE 111
ST CLOUD MN
56303
US

V. Phone/Fax

Practice location:
  • Phone: 320-253-3540
  • Fax: 651-383-4931
Mailing address:
  • Phone: 320-253-3540
  • Fax: 320-253-1475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number1015564-1-MHC
License Number StateMN

VIII. Authorized Official

Name: PAULA J FLANAGAN
Title or Position: BUSINESS MANAGER
Credential:
Phone: 320-253-3540