Provider Demographics
NPI:1184033664
Name:AGAPE COUNSELING SERVICES LLC
Entity Type:Organization
Organization Name:AGAPE COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WHEELER
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC LADC
Authorized Official - Phone:507-316-4815
Mailing Address - Street 1:2746 SUPERIOR DR NW # 350
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-8343
Mailing Address - Country:US
Mailing Address - Phone:507-316-4815
Mailing Address - Fax:
Practice Address - Street 1:2746 SUPERIOR DR NW # 350
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-8343
Practice Address - Country:US
Practice Address - Phone:507-316-4815
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-08
Last Update Date:2015-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN00487261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1538215793Medicaid