1588731327 NPI number — CENTER FOR FAMILY COUNSELING INC

Table of content: (NPI 1588731327)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588731327 NPI number — CENTER FOR FAMILY COUNSELING INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTER FOR FAMILY COUNSELING INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1588731327
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/08/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2025 STEARNS WAY
Provider Second Line Business Mailing Address:
SUITE 111
Provider Business Mailing Address City Name:
ST CLOUD
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56303
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
320-253-3540
Provider Business Mailing Address Fax Number:
320-253-1475

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2025 STEARNS WAY
Provider Second Line Business Practice Location Address:
SUITE 111
Provider Business Practice Location Address City Name:
ST CLOUD
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
320-253-3540
Provider Business Practice Location Address Fax Number:
651-383-4931
Provider Enumeration Date:
11/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FLANAGAN
Authorized Official First Name:
PAULA
Authorized Official Middle Name:
J
Authorized Official Title or Position:
BUSINESS MANAGER
Authorized Official Telephone Number:
320-253-3540

Provider Taxonomy Codes

  • Taxonomy code: 261QM0850X , with the licence number:  1015564-1-MHC , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 74D64CE . This is a "BCBS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 052300300 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




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