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General NPI Number Information
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NPI Number | 1225328180
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Entity Type | Organization
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Legal Business Name | REVIVE COUPLES COUNSELING
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Dates
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Enumeration Date | 04/13/2011
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Last Update Date | 12/30/2011
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Provider Practice Location Address
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Address Line | 311 RAMSEY ST SUITE 205
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City | SAINT PAUL
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State | MN
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Zip | 55102-2323
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Country | US
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Telephone | 715-441-1828
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Fax |
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Provider Business Mailing Address
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Address Line | 423 S FORK DR
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City | HUDSON
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State | WI
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Zip | 54016-8042
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | LMFT/OWNER
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Name | CINDY GRAJKOWSKI
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Credential | MS ED
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Telephone | 715-441-1828
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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 | 1912
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License Number State | MN
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