Provider Demographics
NPI:1275838781
Name:RED RIVER COUNSELING, PLLC
Entity Type:Organization
Organization Name:RED RIVER COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:R
Authorized Official - Last Name:HAMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MS LP
Authorized Official - Phone:218-227-0338
Mailing Address - Street 1:403 CENTER AVE
Mailing Address - Street 2:SUITE 410
Mailing Address - City:MOORHEAD
Mailing Address - State:MN
Mailing Address - Zip Code:56560-1975
Mailing Address - Country:US
Mailing Address - Phone:218-227-0338
Mailing Address - Fax:218-227-0338
Practice Address - Street 1:403 CENTER AVE
Practice Address - Street 2:SUITE 410
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56560-1975
Practice Address - Country:US
Practice Address - Phone:218-227-0338
Practice Address - Fax:218-227-0338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-13
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP 3183103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND18311Medicaid
MN481216600Medicaid