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NPI Code Detail

MEDICARE: THE COUNSELING CLINIC, INC.

MEDICARE: THE COUNSELING CLINIC, INC.
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
1261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number : 1750300620
Entity Type Code : Organization
Provider Name (Legal Business Name) : THE COUNSELING CLINIC, INC.
Provider Business Mailing Address
First Line : 6860 SHINGLE CREEK PKWY
Second Line : SUITE 116
City : BROOKLYN CENTER
State : MN
Zip : 55430-1411
Country : US
Telephone Number : 763-560-4860
Fax Number :
Provider Business Practice Location Address
First Line : 6860 SHINGLE CREEK PKWY
Second Line : SUITE 116
City : BROOKLYN CENTER
State : MN
Zip : 55430-1411
Country : US
Telephone Number : 763-560-4860
Fax Number :
Authorized Official
Title or Position : OWNER/DIRECTOR
Name : DIANE MATHISEN
Credential : MSW, LICSW
Telephone Number : 763-560-4860
Provider Enumeration Date : 07/19/2006
Last Update Date : 08/22/2020

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Directions to “THE COUNSELING CLINIC, INC. ” Practice Location

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