Provider Demographics
NPI:1033360524
Name:TWO OTTERS COUNSELING CENTER, LLC
Entity Type:Organization
Organization Name:TWO OTTERS COUNSELING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SKYE
Authorized Official - Middle Name:V
Authorized Official - Last Name:PAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:218-387-9133
Mailing Address - Street 1:101 W HIGHWAY 61
Mailing Address - Street 2:#60
Mailing Address - City:GRAND MARAIS
Mailing Address - State:MN
Mailing Address - Zip Code:55604-2333
Mailing Address - Country:US
Mailing Address - Phone:218-387-9133
Mailing Address - Fax:218-387-9197
Practice Address - Street 1:101 W HIGHWAY 61
Practice Address - Street 2:#60
Practice Address - City:GRAND MARAIS
Practice Address - State:MN
Practice Address - Zip Code:55604-2333
Practice Address - Country:US
Practice Address - Phone:218-387-9133
Practice Address - Fax:218-387-9197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-02
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP2413103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty