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General NPI Number Information
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NPI Number | 1285004689
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Entity Type | Organization
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Legal Business Name | REDEEM COUNSELING
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Dates
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Enumeration Date | 09/29/2015
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Last Update Date | 09/29/2015
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Provider Practice Location Address
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Address Line | 135 E MAIN ST
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City | CALEDONIA
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State | MN
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Zip | 55921-1319
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Country | US
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Telephone | 507-458-5340
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Fax | 507-725-8136
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Provider Business Mailing Address
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Address Line | 135 E MAIN ST
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City | CALEDONIA
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State | MN
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Zip | 55921-1319
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Country | US
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Telephone | 507-458-5340
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Fax | 507-725-8136
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Authorized Official
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Title or Position | OWNER
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Name | GARY PAUL FOX
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Credential | MA, LPCC
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Telephone | 507-458-5340
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 304236
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | CC00460
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License Number State | MN
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