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General NPI Number Information
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NPI Number | 1053596577
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Entity Type | Organization
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Legal Business Name | NORTHEAST COUNSELING, P.A.
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Dates
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Enumeration Date | 01/03/2008
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Last Update Date | 04/02/2018
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Provider Practice Location Address
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Address Line | 2127 COUNTY ROAD D E STE A100
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City | MAPLEWOOD
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State | MN
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Zip | 55109-5350
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Country | US
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Telephone | 651-592-1592
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Fax | 651-429-2988
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Provider Business Mailing Address
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Address Line | 2127 COUNTY ROAD D E STE A100
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City | MAPLEWOOD
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State | MN
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Zip | 55109-5350
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Country | US
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Telephone | 651-592-1592
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Fax | 651-429-2988
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Authorized Official
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Title or Position | PRESIDENT
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Name | TIM G SCOTT
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Credential | LICSW
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Telephone | 651-398-6341
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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