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General NPI Number Information
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NPI Number | 1629573449
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Entity Type | Organization
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Legal Business Name | NORTHERN PINES COUNSELING CENTER, INC.
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Dates
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Enumeration Date | 03/25/2018
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Last Update Date | 03/25/2018
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Provider Practice Location Address
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Address Line | 277 COON RAPIDS BLVD NW STE 402
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City | COON RAPIDS
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State | MN
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Zip | 55433-5865
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Country | US
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Telephone | 763-234-0240
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Fax | 763-205-1149
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Provider Business Mailing Address
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Address Line | 277 COON RAPIDS BLVD NW STE 402
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City | COON RAPIDS
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State | MN
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Zip | 55433-5865
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Country | US
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Telephone | 763-234-0240
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Fax | 763-205-1149
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | JODI LEE HELSETH
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Credential | LPCC, RPT
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Telephone | 763-234-0240
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number | 00271
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License Number State | MN
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