Healthcare Provider Details

I. General information

NPI: 1427291913
Provider Name (Legal Business Name): COUNSELING PARTNERSHIP, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2009
Last Update Date: 04/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 2ND ST S SUITE 304
WAITE PARK MN
56387-1662
US

IV. Provider business mailing address

110 2ND ST S SUITE 304
WAITE PARK MN
56387-1662
US

V. Phone/Fax

Practice location:
  • Phone: 320-253-4080
  • Fax: 329-253-4088
Mailing address:
  • Phone: 320-253-4080
  • Fax: 329-253-4088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberLP 0423
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License NumberLP 0423
License Number StateMN

VIII. Authorized Official

Name: DR. KATHRYN ANNE LAAKSO
Title or Position: DIRECTOR
Credential: PSY.D., LP
Phone: 320-253-4080