Provider Demographics
NPI:1487034815
Name:TAKE FLIGHT COUNSELING SERVICES LLC
Entity Type:Organization
Organization Name:TAKE FLIGHT COUNSELING SERVICES LLC
Other - Org Name:TAKE FLIGHT COUNSELING SERVICE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CONSTANCE
Authorized Official - Middle Name:LORAINE
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:612-554-9661
Mailing Address - Street 1:4318 34TH AVENUE SOUTH
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55406
Mailing Address - Country:US
Mailing Address - Phone:612-554-9661
Mailing Address - Fax:612-328-9555
Practice Address - Street 1:1821 UNIVERSITY AVE W
Practice Address - Street 2:SUITE# S303
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-2801
Practice Address - Country:US
Practice Address - Phone:612-554-9661
Practice Address - Fax:612-328-9555
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TAKE FLIGHT COUNSELING SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-06-01
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN00607101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN=========OtherEIN
MN475908326OtherSOCIAL SECURITY NUMBER