1841344116 NPI number — WINONA COUNSELING CLINIC, INC.

Table of content: (NPI 1841344116)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841344116 NPI number — WINONA COUNSELING CLINIC, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WINONA COUNSELING CLINIC, 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:
6
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:
1841344116
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/11/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
111 RIVERFRONT
Provider Second Line Business Mailing Address:
SUITE 210
Provider Business Mailing Address City Name:
WINONA
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55987-3456
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
507-454-3900
Provider Business Mailing Address Fax Number:
507-452-7459

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
111 RIVERFRONT
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
WINONA
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55987-3456
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-454-3900
Provider Business Practice Location Address Fax Number:
507-452-7459
Provider Enumeration Date:
01/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSON
Authorized Official First Name:
MICHELLE
Authorized Official Middle Name:
L
Authorized Official Title or Position:
DIRECTOR / OWNER
Authorized Official Telephone Number:
507-454-3900

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  1028139-1-MHC , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251S00000X , with the licence number: 8306881CDT , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X , with the licence number: 2009 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 38266WI . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 128661 . This is a "UCARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 9166WI . This is a "BLUE CROSS BLUE SHIELD CD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 326930 . This is a "VALUE OPTIONS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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