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General NPI Number Information
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NPI Number | 1952544629
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Entity Type | Organization
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Legal Business Name | MARKETPLACE COUNSELING, PA
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Dates
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Enumeration Date | 04/10/2009
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Last Update Date | 04/10/2009
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Provider Practice Location Address
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Address Line | 110 2ND ST S SUITE 304
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City | WAITE PARK
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State | MN
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Zip | 56387-1662
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Country | US
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Telephone | 320-253-4080
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Fax |
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Provider Business Mailing Address
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Address Line | 110 2ND ST S SUITE 304
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City | WAITE PARK
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State | MN
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Zip | 56387-1662
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Country | US
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Telephone | 320-253-4080
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Fax |
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Authorized Official
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Title or Position | PSYCHOTHERAPIST
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Name | STEVEN ALEKSANDER GRIBAS
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Credential | MS, LICSW, LADC
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Telephone | 320-253-4080
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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 | 300992
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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 | 11987
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License Number State | MN
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