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General NPI Number Information
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NPI Number | 1841344116
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Entity Type | Organization
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Legal Business Name | WINONA COUNSELING CLINIC, INC.
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Dates
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Enumeration Date | 01/23/2007
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Last Update Date | 04/11/2012
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Provider Practice Location Address
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Address Line | 111 RIVERFRONT SUITE 210
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City | WINONA
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State | MN
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Zip | 55987-3456
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Country | US
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Telephone | 507-454-3900
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Fax | 507-452-7459
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Provider Business Mailing Address
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Address Line | 111 RIVERFRONT SUITE 210
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City | WINONA
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State | MN
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Zip | 55987-3456
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Country | US
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Telephone | 507-454-3900
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Fax | 507-452-7459
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Authorized Official
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Title or Position | DIRECTOR / OWNER
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Name | MS. MICHELLE L JOHNSON
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Credential | MS, LPCC, LPC, LADC
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Telephone | 507-454-3900
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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 | 8306881CDT
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 2009
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 1028139-1-MHC
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License Number State | MN
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