Provider Demographics
NPI:1093486722
Name:TWO RIVERS COUNSELING LLC
Entity Type:Organization
Organization Name:TWO RIVERS COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EVE-LYNN
Authorized Official - Middle Name:R
Authorized Official - Last Name:FELLERSEN
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:218-606-1100
Mailing Address - Street 1:404 W SUPERIOR ST STE 210
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55802-1569
Mailing Address - Country:US
Mailing Address - Phone:218-606-1100
Mailing Address - Fax:218-520-1799
Practice Address - Street 1:404 W SUPERIOR ST STE 210
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802-1569
Practice Address - Country:US
Practice Address - Phone:218-606-1100
Practice Address - Fax:218-520-1799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-22
Last Update Date:2023-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251S00000XAgenciesCommunity/Behavioral Health