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General NPI Number Information
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NPI Number | 1114220811
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL COUNSELING CENTER
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Dates
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Enumeration Date | 12/19/2010
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Last Update Date | 12/19/2010
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Provider Practice Location Address
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Address Line | 620 HIGHWAY 12 E
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City | DELANO
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State | MN
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Zip | 55328-8603
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Country | US
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Telephone | 763-972-6527
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Fax |
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Provider Business Mailing Address
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Address Line | 620 HIGHWAY 12 E PO BOX 558
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City | DELANO
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State | MN
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Zip | 55328-8603
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Country | US
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Telephone | 763-972-6527
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Fax |
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Authorized Official
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Title or Position | OWNER, DIRECTOR
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Name | DR. LOIS COCHRANE SCHLUTTER
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Credential | PH.D. L.P.
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Telephone | 952-548-9340
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 1058894
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 1058894
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License Number State | MN
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