=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093268906
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOPE COUNSELING CENTER LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/27/2016
-----------------------------------------------------
Last Update Date | 12/22/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 421 1ST AVE SW SUITE 300W
-----------------------------------------------------
City | ROCHESTER
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55902-3389
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 507-250-6234
-----------------------------------------------------
Fax | 507-322-6262
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5439 ABBEY LN SE
-----------------------------------------------------
City | ROCHESTER
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55904-8114
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 507-250-6234
-----------------------------------------------------
Fax | 507-322-6262
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | MS. CHRISTINE LOUISE HAYDEN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 715-530-4495
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | CC00933
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------