Provider Demographics
NPI:1144228776
Name:WOODCREST COUNSELING, INC
Entity Type:Organization
Organization Name:WOODCREST COUNSELING, INC
Other - Org Name:THOMAS M GRASKE, M.A., L.P.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PSYCHOLOGIST / OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:GRASKE
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LP
Authorized Official - Phone:763-753-1785
Mailing Address - Street 1:521 TANGLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SHOREVIEW
Mailing Address - State:MN
Mailing Address - Zip Code:55126-2016
Mailing Address - Country:US
Mailing Address - Phone:763-753-1785
Mailing Address - Fax:763-753-1753
Practice Address - Street 1:521 TANGLEWOOD DR
Practice Address - Street 2:
Practice Address - City:SHOREVIEW
Practice Address - State:MN
Practice Address - Zip Code:55126-2016
Practice Address - Country:US
Practice Address - Phone:763-753-1785
Practice Address - Fax:763-753-1753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP3334103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNLP3334OtherMN BOARD OF PSYCHOLOGY