Provider Demographics
NPI:1083979207
Name:DD OPATZ COUNSELING, LLC
Entity Type:Organization
Organization Name:DD OPATZ COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / SOLE MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:DOCKENDORF
Authorized Official - Last Name:OPATZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-309-8789
Mailing Address - Street 1:823 ALDON DRIVE
Mailing Address - Street 2:
Mailing Address - City:ST. CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56301
Mailing Address - Country:US
Mailing Address - Phone:320-309-8789
Mailing Address - Fax:
Practice Address - Street 1:3333 W. DIVISION ST. STE 100
Practice Address - Street 2:MIDTOWN SQUARE
Practice Address - City:ST. CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303
Practice Address - Country:US
Practice Address - Phone:320-339-3226
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-13
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN19021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty