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General NPI Number Information
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NPI Number | 1669773768
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Entity Type | Organization
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Legal Business Name | SHALOM COUNSELING & CONSULTING, LLC
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Dates
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Enumeration Date | 11/06/2010
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Last Update Date | 11/06/2010
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Provider Practice Location Address
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Address Line | 204 2ND ST
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City | JACKSON
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State | MN
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Zip | 56143-1638
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Country | US
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Telephone | 507-841-0728
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Fax | 507-847-4750
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Provider Business Mailing Address
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Address Line | 204 2ND ST P.O. BOX 223
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City | JACKSON
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State | MN
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Zip | 56143-1638
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Country | US
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Telephone | 507-841-0728
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Fax | 507-847-4750
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Authorized Official
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Title or Position | MANAGER
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Name | CHARLOTTE DIANE LOEWEN
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Credential | MSW, LICSW
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Telephone | 507-841-0728
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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 | 14441
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License Number State | MN
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