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General NPI Number Information
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NPI Number | 1407044886
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Entity Type | Organization
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Legal Business Name | DBA MARK PERKINS COUNSELING
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Dates
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Enumeration Date | 10/10/2007
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Last Update Date | 01/03/2017
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Provider Practice Location Address
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Address Line | 1500 1ST AVE NE SUITE 111-D
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City | ROCHESTER
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State | MN
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Zip | 55906-4170
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Country | US
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Telephone | 507-529-1758
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Fax | 507-289-1536
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Provider Business Mailing Address
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Address Line | 2247 68TH ST NW
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City | ROCHESTER
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State | MN
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Zip | 55901-8862
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Country | US
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Telephone | 507-529-1758
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. MARK GREGORY PERKINS
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Credential | LADC
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Telephone | 507-529-1758
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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 | 10475091CDT
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License Number State | MN
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