Provider Demographics
NPI:1073680583
Name:TOLLEFSON COUNSELING SERVICES
Entity Type:Organization
Organization Name:TOLLEFSON COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:TOLLEFSON
Authorized Official - Suffix:
Authorized Official - Credentials:MA LP
Authorized Official - Phone:763-295-3207
Mailing Address - Street 1:PO BOX 546
Mailing Address - Street 2:261 EAST BROADWAY
Mailing Address - City:MONTICELLO
Mailing Address - State:MN
Mailing Address - Zip Code:55362-0546
Mailing Address - Country:US
Mailing Address - Phone:763-295-3207
Mailing Address - Fax:763-295-6666
Practice Address - Street 1:261 E BROADWAY ST
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:MN
Practice Address - Zip Code:55362-9317
Practice Address - Country:US
Practice Address - Phone:763-295-3207
Practice Address - Fax:763-295-6666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP2285103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN333J4TOOtherBCBS
MN110707OtherUCARE
MN6234967OtherUBH