Provider Demographics
NPI:1407044886
Name:DBA MARK PERKINS COUNSELING
Entity Type:Organization
Organization Name:DBA MARK PERKINS COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:GREGORY
Authorized Official - Last Name:PERKINS
Authorized Official - Suffix:
Authorized Official - Credentials:LADC
Authorized Official - Phone:507-529-1758
Mailing Address - Street 1:2247 68TH ST NW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-8862
Mailing Address - Country:US
Mailing Address - Phone:507-529-1758
Mailing Address - Fax:
Practice Address - Street 1:1500 1ST AVE NE
Practice Address - Street 2:SUITE 111-D
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55906-4170
Practice Address - Country:US
Practice Address - Phone:507-529-1758
Practice Address - Fax:507-289-1536
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PERKINS ENTERPRISES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-10
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10475091CDT251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1407044886OtherNPI