Provider Demographics
NPI:1073789939
Name:THEODORE J. PIERZINA
Entity Type:Organization
Organization Name:THEODORE J. PIERZINA
Other - Org Name:COUNSELING CLINIC LA CRESCENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:J
Authorized Official - Last Name:PIERZINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-895-6666
Mailing Address - Street 1:33 S WALNUT ST STE 100
Mailing Address - Street 2:
Mailing Address - City:LA CRESCENT
Mailing Address - State:MN
Mailing Address - Zip Code:55947-1319
Mailing Address - Country:US
Mailing Address - Phone:507-895-6666
Mailing Address - Fax:
Practice Address - Street 1:33 S WALNUT ST STE 100
Practice Address - Street 2:
Practice Address - City:LA CRESCENT
Practice Address - State:MN
Practice Address - Zip Code:55947-1319
Practice Address - Country:US
Practice Address - Phone:507-895-6666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-01
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1016047-1-CDT251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health