Provider Demographics
NPI:1093999062
Name:FALCK, MICHAEL ELLIOT (LICSW, CPRP, MA)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ELLIOT
Last Name:FALCK
Suffix:
Gender:M
Credentials:LICSW, CPRP, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5615 BROOKLYN BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:55429-3086
Mailing Address - Country:US
Mailing Address - Phone:763-537-6612
Mailing Address - Fax:763-537-7162
Practice Address - Street 1:5615 BROOKLYN BLVD STE 200
Practice Address - Street 2:
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55429-3086
Practice Address - Country:US
Practice Address - Phone:763-537-6612
Practice Address - Fax:763-537-7162
Is Sole Proprietor?:No
Enumeration Date:2007-12-26
Last Update Date:2007-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN167061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical