Provider Demographics
NPI:1477821791
Name:PROFESSIONAL COUNSELING CENTER
Entity Type:Organization
Organization Name:PROFESSIONAL COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:GRILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-548-9340
Mailing Address - Street 1:12450 WAYZATA BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55305-1927
Mailing Address - Country:US
Mailing Address - Phone:952-548-9340
Mailing Address - Fax:952-548-9350
Practice Address - Street 1:12450 WAYZATA BLVD STE 202
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-1927
Practice Address - Country:US
Practice Address - Phone:952-548-9340
Practice Address - Fax:952-548-9350
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHERN INTEGRATED HEALTH INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-12-01
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No251S00000XAgenciesCommunity/Behavioral Health