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General NPI Number Information
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NPI Number | 1952841413
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Entity Type | Organization
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Legal Business Name | PRAIRIE FAMILY COUNSELING, LLC
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Dates
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Enumeration Date | 03/03/2017
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Last Update Date | 02/23/2023
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Provider Practice Location Address
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Address Line | 210 20TH ST S
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City | NEW ULM
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State | MN
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Zip | 56073
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Country | US
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Telephone | 507-766-7685
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Fax | 507-216-6600
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Provider Business Mailing Address
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Address Line | PO BOX 743
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City | NEW ULM
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State | MN
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Zip | 56073-2223
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Country | US
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Telephone | 507-766-7685
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Fax | 507-216-6600
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | CHRISTOPHER BRYS DAVIS
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Credential | LICSW
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Telephone | 507-766-7685
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 17460
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License Number State | MN
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