Provider Demographics
NPI:1114220811
Name:PROFESSIONAL COUNSELING CENTER
Entity Type:Organization
Organization Name:PROFESSIONAL COUNSELING CENTER
Other - Org Name:PROFESSIONAL COUNSELING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LOIS
Authorized Official - Middle Name:COCHRANE
Authorized Official - Last Name:SCHLUTTER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD LP
Authorized Official - Phone:952-548-9340
Mailing Address - Street 1:620 HIGHWAY 12 E
Mailing Address - Street 2:PO BOX 558
Mailing Address - City:DELANO
Mailing Address - State:MN
Mailing Address - Zip Code:55328-8603
Mailing Address - Country:US
Mailing Address - Phone:763-972-6527
Mailing Address - Fax:
Practice Address - Street 1:620 HIGHWAY 12 E
Practice Address - Street 2:
Practice Address - City:DELANO
Practice Address - State:MN
Practice Address - Zip Code:55328-8603
Practice Address - Country:US
Practice Address - Phone:763-972-6527
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHERN INTEGRATED HEALTH, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-12-19
Last Update Date:2010-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1058894101YA0400X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty