Provider Demographics
NPI:1194836064
Name:AFFILIATED COUNSELING CENTER
Entity Type:Organization
Organization Name:AFFILIATED COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:MARTINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-572-2605
Mailing Address - Street 1:7260 UNIVERSITY AVE NE
Mailing Address - Street 2:SUITE 235
Mailing Address - City:FRIDLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55432-3126
Mailing Address - Country:US
Mailing Address - Phone:763-572-2605
Mailing Address - Fax:763-572-2606
Practice Address - Street 1:7260 UNIVERSITY AVE NE
Practice Address - Street 2:SUITE 235
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432-3126
Practice Address - Country:US
Practice Address - Phone:763-572-2605
Practice Address - Fax:763-572-2606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLPC 103101YP2500X
MNLP 3668103T00000X
MNLMFT 1081106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty