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NPI Code Detail

MEDICARE: TOLLEFSON COUNSELING SERVICES

MEDICARE: TOLLEFSON COUNSELING SERVICES
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical PsychologistLP2285MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1333J4TOOTHERMNBCBS
2110707OTHERMNUCARE
36234967OTHERMNUBH

General Provider Information

NPI Number : 1073680583
Entity Type Code : Organization
Provider Name (Legal Business Name) : TOLLEFSON COUNSELING SERVICES
Provider Business Mailing Address
First Line : PO BOX 546
Second Line : 261 EAST BROADWAY
City : MONTICELLO
State : MN
Zip : 55362-0546
Country : US
Telephone Number : 763-295-3207
Fax Number : 763-295-6666
Provider Business Practice Location Address
First Line : 261 E BROADWAY ST
Second Line :
City : MONTICELLO
State : MN
Zip : 55362-9317
Country : US
Telephone Number : 763-295-3207
Fax Number : 763-295-6666
Authorized Official
Title or Position : PRESIDENT
Name : BARBARA JEAN TOLLEFSON
Credential : MA LP
Telephone Number : 763-295-3207
Provider Enumeration Date : 11/29/2006
Last Update Date : 08/22/2020

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