Provider Demographics
NPI:1467122804
Name:ABUNDANT PEACE COUNSELING PC
Entity Type:Organization
Organization Name:ABUNDANT PEACE COUNSELING PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PROEBSTLE
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPCC
Authorized Official - Phone:651-683-0000
Mailing Address - Street 1:3763 DENMARK TRL W
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55123-1010
Mailing Address - Country:US
Mailing Address - Phone:651-683-0000
Mailing Address - Fax:888-425-4826
Practice Address - Street 1:4141 OLD SIBLEY MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-1996
Practice Address - Country:US
Practice Address - Phone:612-888-3858
Practice Address - Fax:888-425-4826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-16
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty