Provider Demographics
NPI:1093268906
Name:HOPE COUNSELING CENTER LLC
Entity Type:Organization
Organization Name:HOPE COUNSELING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:HAYDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-530-4495
Mailing Address - Street 1:5439 ABBEY LN SE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55904-8114
Mailing Address - Country:US
Mailing Address - Phone:507-250-6234
Mailing Address - Fax:507-322-6262
Practice Address - Street 1:421 1ST AVE SW
Practice Address - Street 2:SUITE 300W
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55902-3389
Practice Address - Country:US
Practice Address - Phone:507-250-6234
Practice Address - Fax:507-322-6262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-27
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC00933251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN13511949OtherCAQH