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General NPI Number Information
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NPI Number | 1952712572
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Entity Type | Organization
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Legal Business Name | CAMBRIDGE COUNSELING CENTER, LLC
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Dates
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Enumeration Date | 05/16/2014
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Last Update Date | 05/16/2014
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Provider Practice Location Address
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Address Line | 121 ADAMS ST S
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City | CAMBRIDGE
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State | MN
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Zip | 55008-1620
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Country | US
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Telephone | 763-442-4111
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Fax |
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Provider Business Mailing Address
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Address Line | 21221 FOXTAIL LN
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City | ROGERS
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State | MN
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Zip | 55374-6512
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Country | US
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Telephone | 763-443-2096
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MICHAEL KELLER
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Credential | LP
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Telephone | 763-442-4111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | LP4821
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License Number State | MN
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