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1285905885

NPI Code Detail

MEDICARE: SECURE BASE COUNSELING CENTER LLC

MEDICARE: SECURE BASE COUNSELING CENTER LLC

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
1	171R00000X	Interpreter
2	2080P0006X	Developmental - Behavioral Pediatrics Physician
3	2084P0800X	Psychiatry Physician
4	2084P0804X	Child & Adolescent Psychiatry Physician
5	225X00000X	Occupational Therapist
6	235Z00000X	Speech-Language Pathologist
7	363LP0200X	Pediatric Nurse Practitioner
8	1041C0700X	Clinical Social Worker
9	106H00000X	Marriage & Family Therapist
10	133V00000X	Registered Dietitian
11	163W00000X	Registered Nurse
12	163WP0808X	Psychiatric/Mental Health Registered Nurse
13	164W00000X	Licensed Practical Nurse
14	363LP0808X	Psychiatric/Mental Health Nurse Practitioner
15	103T00000X	Psychologist	LP4079	MN

General Provider Information

NPI Number	:	1285905885
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SECURE BASE COUNSELING CENTER LLC

Provider Business Mailing Address
First Line	:	570 PROFESSIONAL DR
Second Line	:
City	:	NORTHFIELD
State	:	MN
Zip	:	55057-2756
Country	:	US
Telephone Number	:	507-301-3412
Fax Number	:

Provider Business Practice Location Address
First Line	:	570 PROFESSIONAL DR
Second Line	:
City	:	NORTHFIELD
State	:	MN
Zip	:	55057-2756
Country	:	US
Telephone Number	:	507-301-3412
Fax Number	:

Authorized Official
Title or Position	:	CEO/OWNER
Name	:	MS. JENNIFER LYNN SIMPSON-DAHL
Credential	:	MA, LMFT
Telephone Number	:	507-301-3412

Provider Enumeration Date	:	01/13/2012
Last Update Date	:	03/30/2022

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1861858466 — THERESE HOUNDT-DALBERG APRN, PMHNP-BC
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Directions to “SECURE BASE COUNSELING CENTER LLC ” Practice Location

Language	Start Address	Practice Location

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