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General NPI Number Information
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NPI Number | 1285905885
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Entity Type | Organization
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Legal Business Name | SECURE BASE COUNSELING CENTER LLC
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Dates
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Enumeration Date | 01/13/2012
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Last Update Date | 03/30/2022
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Provider Practice Location Address
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Address Line | 570 PROFESSIONAL DR
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City | NORTHFIELD
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State | MN
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Zip | 55057-2756
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Country | US
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Telephone | 507-301-3412
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Fax |
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Provider Business Mailing Address
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Address Line | 570 PROFESSIONAL DR
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City | NORTHFIELD
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State | MN
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Zip | 55057-2756
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Country | US
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Telephone | 507-301-3412
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Fax |
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Authorized Official
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Title or Position | CEO/OWNER
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Name | MS. JENNIFER LYNN SIMPSON-DAHL
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Credential | MA, LMFT
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Telephone | 507-301-3412
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171R00000X
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Taxonomy Name | Interpreter
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2080P0006X
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Taxonomy Name | Developmental - Behavioral Pediatrics Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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Taxonomy #10
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State |
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Taxonomy #11
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number |
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License Number State |
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Taxonomy #12
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Taxonomy Code | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number |
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License Number State |
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Taxonomy #13
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number |
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License Number State |
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Taxonomy #14
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #15
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | LP4079
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License Number State | MN
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