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General NPI Number Information
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NPI Number | 1669849808
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Entity Type | Organization
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Legal Business Name | JACQUI RUZICKA COUNSELING SERVICES, LLC
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Dates
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Enumeration Date | 08/24/2015
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Last Update Date | 04/01/2022
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Provider Practice Location Address
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Address Line | 255 HIGHWAY 7 E
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City | HUTCHINSON
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State | MN
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Zip | 55350-1749
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Country | US
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Telephone | 320-282-2591
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Fax |
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Provider Business Mailing Address
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Address Line | 225 3RD AVE NW
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City | HUTCHINSON
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State | MN
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Zip | 55350-1623
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Country | US
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Telephone | 320-455-9888
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Fax |
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Authorized Official
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Title or Position | THERAPIST, OWNER
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Name | JACQUELINE MARIE THEISEN
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Credential | NCC, LPCC
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Telephone | 320-282-2591
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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 |
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License Number State | MN
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