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NPI Code Detail

MEDICARE: THE WOODS THERAPY AND COUNSELING SERVICES, PLLC

MEDICARE: THE WOODS THERAPY AND COUNSELING SERVICES, PLLC
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
11041C0700XClinical Social Worker

General Provider Information

NPI Number : 1851985022
Entity Type Code : Organization
Provider Name (Legal Business Name) : THE WOODS THERAPY AND COUNSELING SERVICES, PLLC
Provider Business Mailing Address
First Line : 1120 NW 4TH ST
Second Line :
City : GRAND RAPIDS
State : MN
Zip : 55744-2251
Country : US
Telephone Number : 218-999-4661
Fax Number :
Provider Business Practice Location Address
First Line : 1120 NW 4TH ST
Second Line :
City : GRAND RAPIDS
State : MN
Zip : 55744-2251
Country : US
Telephone Number : 218-999-4661
Fax Number :
Authorized Official
Title or Position : OWNER
Name : MR. MICHAEL ROCKY HARBIN
Credential : LICSW
Telephone Number : 218-259-5511
Provider Enumeration Date : 02/26/2021
Last Update Date : 02/26/2021

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